1. Victor Satisfaction Survey

Our goal at Victor is to provide you with exceptional service. Would you please take a moment to provide us with feedback regarding the services you received?
(Please check one for each question)

Please respond to the following:

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* 1. Please respond to the following:

What services did you receive?

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* 2. What services did you receive?

Check One:

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* 4. Check One:

Overall I am satisfied with the services I received from Victor.

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* 5. Overall I am satisfied with the services I received from Victor.

The intake and assessment process was effective and efficient.

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* 6. The intake and assessment process was effective and efficient.

My questions and concerns were addressed in a timely manner.

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* 7. My questions and concerns were addressed in a timely manner.

The program involved me in treatment/service planning.

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* 8. The program involved me in treatment/service planning.

The staff was professional and helpful.

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* 9. The staff was professional and helpful.

Appointments and meetings were scheduled collaboratively.

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* 10. Appointments and meetings were scheduled collaboratively.

Psychiatric/medication support services were available and appropriate.

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* 11. Psychiatric/medication support services were available and appropriate.

The staff was respectful of my values and culture.

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* 12. The staff was respectful of my values and culture.

If I was to seek help again, I would use your program.

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* 13. If I was to seek help again, I would use your program.

How long have you received services from our agency?

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* 14. How long have you received services from our agency?

What other information would you like to share with us about your services?

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* 15. What other information would you like to share with us about your services?

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