CLIENT SERVICES FEEDBACK SURVEY

At South Coast Wellness Addiction and Mental Health we are committed to providing the highest quality services and professional support. In order to maintain this committment we are always open to learning about the experiences of our clients. Below are (11) questions and a comment section that we hope you will complete and share with us. The information will be confidential. You do not need to share your name or address. However, at the end we will ask if you wish to speak to someone so that we can further learn from your experience. If you respond yes, we will ask for your name and contact information.
Please rate each question using the 5 point scale: 1 Totally Disagree; 2 Disagree; 3 Not sure; 4 Agree; 5 Fully Agree
1. The intake process provided was informative and professional?
Totally Disagree
Disagree
Not Sure
Agree
Fully Agree
2. I was clearly informed of my rights and responsibilities?
Totally Disagree
Disagree
Not Sure
Agree
Fully Agre
3. I was heard and felt cared for by my worker?
Totally Disagree
Disagree
Not Sure
Agree
Fully Agree
4. I was provided with excellent resources when necessary?
Totally Disagree
Disagree
Not Sure
Agree
Fully Agree
5. When issues arose, they were satisfactorily addressed?
Totally Disagree
Disagree
Not Sure
Agree
Fully Agree
6. I experienced concerns I believe are related to my gender, race, or ethnicity?
Totally Disagree
Disagree
Not Sure
Agree
Fully Agree
7. I felt that I had the right number of sessions to meet my needs?
Totally Disagree
Disagree
Not Sure
Agree
Fully Agree
8. The overall physical loction was pleasant and welcoming?
Totally Disagree
Disagree
Not Sure
Agree
Fully Agree
9. I would recommend South Coast Wellness to friends and family?
Totally Disagree
Disagree
Not Sure
Agree
Fully Agree
10. I would return to South Coast Wellness if other issues arose?
Totally Disagree
Disagree
Not Sure
Agree
Fully Agree
11. Overall I am satisfied with services?
Totally Disagree
Disagree
Not Sure
Agree
Fully Agree
Is there anything else you would like to share?
Comments
If you would like to be contacted to discuss further, please leave your name and contact information below:
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