1. Western Psychological and Counseling, PC

Chemical Dependency Treatment Program

Your comments are valuable to us. Please take a few moments to read and complete this client satisfaction questionnaire. Your remarks will remain confidential and will assist Western in improving the services we provide.

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* Name: (Optional)

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* Please indicate the program site (Required):

  Beaverton Gladstone Vancouver
Office

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* Please indicate your Referral Source

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* Please indicate your opinion of the following subjects:

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Admission Process
Evaluation Process
Treatment Planning
Group Sessions
Individual Sessions
Family Sessions
Videos/DVDs
Office Staff
Billing Office Staff
Facility (Lobby, Group rooms, etc.)
Value of Program Curriculum
Communication with referral source
How well were you prepared for Discharge

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* Please indicate your opinion regarding your Counselor

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Counselor

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