CLIENT SATISFACTION SURVEY- 2023-2024

By completing the questions below, you will support our Performance Improvement Activities thus allowing us to provide better services and improved business practices Your answers are confidential and will not influence your treatment in any manner. Put a cross (X) in the box that best describes your answer. Thank you!!!

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* 1. Location

New Brunswick Counseling Center

Burlington Comprehensive Clinic

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* 2. What is your gender?

Female

Male

Prefer not to say

Other (please specify)

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* 3. Which of the following categories best describes your employment status?

Employed, working full-time

Employed, working part-time

Not employed, looking for work

Not employed, NOT looking for work

Retired

Disabled, not able to work

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* 4. Program:

MAT- Methadone- Buprenorphine- Vivitrol

SUD- Outpatient Drug Free

Mental Health

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* 5. Time in Program

Less than 3 months

3-6Months

7-12 Months

1 year to 2 years

Greater than 2 years

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* 6. Living Arrangements

Homeless

Dependent/Supervised Living

Independent Living

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* 7. What is your age?

18 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 or older

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* 8. Health Insurance

Medicaid

Medicare

Private Insurance

 No Insurance

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* 9. Access/Admission/Orientation

	Strongly Disagree	Disagree	Agree	Strongly Agree	Does not Apply
I was admitted to the program in a reasonable amount of time.	I was admitted to the program in a reasonable amount of time. Strongly Disagree	I was admitted to the program in a reasonable amount of time. Disagree	I was admitted to the program in a reasonable amount of time. Agree	I was admitted to the program in a reasonable amount of time. Strongly Agree	I was admitted to the program in a reasonable amount of time. Does not Apply
I reviewed and was provided a Handbook (Guide to Services) that explained the program rules, program limitations, as well as financial responsibilities including billing, no show policy, and insurance information.	I reviewed and was provided a Handbook (Guide to Services) that explained the program rules, program limitations, as well as financial responsibilities including billing, no show policy, and insurance information. Strongly Disagree	I reviewed and was provided a Handbook (Guide to Services) that explained the program rules, program limitations, as well as financial responsibilities including billing, no show policy, and insurance information. Disagree	I reviewed and was provided a Handbook (Guide to Services) that explained the program rules, program limitations, as well as financial responsibilities including billing, no show policy, and insurance information. Agree	I reviewed and was provided a Handbook (Guide to Services) that explained the program rules, program limitations, as well as financial responsibilities including billing, no show policy, and insurance information. Strongly Agree	I reviewed and was provided a Handbook (Guide to Services) that explained the program rules, program limitations, as well as financial responsibilities including billing, no show policy, and insurance information. Does not Apply
The Mission, Values, and Goals of the Program were explained to me.	The Mission, Values, and Goals of the Program were explained to me. Strongly Disagree	The Mission, Values, and Goals of the Program were explained to me. Disagree	The Mission, Values, and Goals of the Program were explained to me. Agree	The Mission, Values, and Goals of the Program were explained to me. Strongly Agree	The Mission, Values, and Goals of the Program were explained to me. Does not Apply

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* 10. Referrals, Transition and/or Discharge

	Strongly Disagree	Disagree	Agree	Strongly Agree	Does not Apply
I was provided with relevant community referrals when I asked for them or as the staff became aware of my need.	I was provided with relevant community referrals when I asked for them or as the staff became aware of my need. Strongly Disagree	I was provided with relevant community referrals when I asked for them or as the staff became aware of my need. Disagree	I was provided with relevant community referrals when I asked for them or as the staff became aware of my need. Agree	I was provided with relevant community referrals when I asked for them or as the staff became aware of my need. Strongly Agree	I was provided with relevant community referrals when I asked for them or as the staff became aware of my need. Does not Apply
If a level of care change or other type of Transition occurred, I was informed and participated in this change	If a level of care change or other type of Transition occurred, I was informed and participated in this change Strongly Disagree	If a level of care change or other type of Transition occurred, I was informed and participated in this change Disagree	If a level of care change or other type of Transition occurred, I was informed and participated in this change Agree	If a level of care change or other type of Transition occurred, I was informed and participated in this change Strongly Agree	If a level of care change or other type of Transition occurred, I was informed and participated in this change Does not Apply

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* 11. Input from Persons Served

	Strongly Disagree	Disagree	Agree	Strongly Agree	Does not Apply
People who work here seem interested in my progress and the services provided.	People who work here seem interested in my progress and the services provided. Strongly Disagree	People who work here seem interested in my progress and the services provided. Disagree	People who work here seem interested in my progress and the services provided. Agree	People who work here seem interested in my progress and the services provided. Strongly Agree	People who work here seem interested in my progress and the services provided. Does not Apply
I am encouraged to give my opinion about my treatment, the staff, as well as the program and services.	I am encouraged to give my opinion about my treatment, the staff, as well as the program and services. Strongly Disagree	I am encouraged to give my opinion about my treatment, the staff, as well as the program and services. Disagree	I am encouraged to give my opinion about my treatment, the staff, as well as the program and services. Agree	I am encouraged to give my opinion about my treatment, the staff, as well as the program and services. Strongly Agree	I am encouraged to give my opinion about my treatment, the staff, as well as the program and services. Does not Apply
There are several different ways to offer feedback about the program (suggestion box, satisfaction survey, online survey, etc.).	There are several different ways to offer feedback about the program (suggestion box, satisfaction survey, online survey, etc.). Strongly Disagree	There are several different ways to offer feedback about the program (suggestion box, satisfaction survey, online survey, etc.). Disagree	There are several different ways to offer feedback about the program (suggestion box, satisfaction survey, online survey, etc.). Agree	There are several different ways to offer feedback about the program (suggestion box, satisfaction survey, online survey, etc.). Strongly Agree	There are several different ways to offer feedback about the program (suggestion box, satisfaction survey, online survey, etc.). Does not Apply

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* 12. Rights and Responsibilities

	Strongly Disagree	Disagree	Agree	Strongly Agree	Does not Apply
My rights and responsibilities were clearly explained to me and I was offered a copy for my records.	My rights and responsibilities were clearly explained to me and I was offered a copy for my records. Strongly Disagree	My rights and responsibilities were clearly explained to me and I was offered a copy for my records. Disagree	My rights and responsibilities were clearly explained to me and I was offered a copy for my records. Agree	My rights and responsibilities were clearly explained to me and I was offered a copy for my records. Strongly Agree	My rights and responsibilities were clearly explained to me and I was offered a copy for my records. Does not Apply
If something happens that I don’t like or I feel like my rights have been violated, I know how to file a complaint or a grievance	If something happens that I don’t like or I feel like my rights have been violated, I know how to file a complaint or a grievance Strongly Disagree	If something happens that I don’t like or I feel like my rights have been violated, I know how to file a complaint or a grievance Disagree	If something happens that I don’t like or I feel like my rights have been violated, I know how to file a complaint or a grievance Agree	If something happens that I don’t like or I feel like my rights have been violated, I know how to file a complaint or a grievance Strongly Agree	If something happens that I don’t like or I feel like my rights have been violated, I know how to file a complaint or a grievance Does not Apply
Duty to Warn and Limits to Confidentiality were explained to me.	Duty to Warn and Limits to Confidentiality were explained to me. Strongly Disagree	Duty to Warn and Limits to Confidentiality were explained to me. Disagree	Duty to Warn and Limits to Confidentiality were explained to me. Agree	Duty to Warn and Limits to Confidentiality were explained to me. Strongly Agree	Duty to Warn and Limits to Confidentiality were explained to me. Does not Apply

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* 13. The Assessment Process

	Strongly Disagree	Disagree	Agree	Strongly Agree	Does not Apply
My needs were identified and discussed with an educated and respectful staff member.	My needs were identified and discussed with an educated and respectful staff member. Strongly Disagree	My needs were identified and discussed with an educated and respectful staff member. Disagree	My needs were identified and discussed with an educated and respectful staff member. Agree	My needs were identified and discussed with an educated and respectful staff member. Strongly Agree	My needs were identified and discussed with an educated and respectful staff member. Does not Apply
I felt heard, listened to, and safe when disclosing my reasons for seeking services.	I felt heard, listened to, and safe when disclosing my reasons for seeking services. Strongly Disagree	I felt heard, listened to, and safe when disclosing my reasons for seeking services. Disagree	I felt heard, listened to, and safe when disclosing my reasons for seeking services. Agree	I felt heard, listened to, and safe when disclosing my reasons for seeking services. Strongly Agree	I felt heard, listened to, and safe when disclosing my reasons for seeking services. Does not Apply
I felt respected when sharing my history and developing a plan for services.	I felt respected when sharing my history and developing a plan for services. Strongly Disagree	I felt respected when sharing my history and developing a plan for services. Disagree	I felt respected when sharing my history and developing a plan for services. Agree	I felt respected when sharing my history and developing a plan for services. Strongly Agree	I felt respected when sharing my history and developing a plan for services. Does not Apply

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* 14. Treatment Planning

	Strongly Disagree	Disagree	Agree	Strongly Agree	Does not Apply
I participated in the development of my treatment plan and/or was offered a copy	I participated in the development of my treatment plan and/or was offered a copy Strongly Disagree	I participated in the development of my treatment plan and/or was offered a copy Disagree	I participated in the development of my treatment plan and/or was offered a copy Agree	I participated in the development of my treatment plan and/or was offered a copy Strongly Agree	I participated in the development of my treatment plan and/or was offered a copy Does not Apply
I signed and reviewed my treatment goals and objectives on a regular basis	I signed and reviewed my treatment goals and objectives on a regular basis Strongly Disagree	I signed and reviewed my treatment goals and objectives on a regular basis Disagree	I signed and reviewed my treatment goals and objectives on a regular basis Agree	I signed and reviewed my treatment goals and objectives on a regular basis Strongly Agree	I signed and reviewed my treatment goals and objectives on a regular basis Does not Apply
My treatment plan is revised or updated when things change or at my request.	My treatment plan is revised or updated when things change or at my request. Strongly Disagree	My treatment plan is revised or updated when things change or at my request. Disagree	My treatment plan is revised or updated when things change or at my request. Agree	My treatment plan is revised or updated when things change or at my request. Strongly Agree	My treatment plan is revised or updated when things change or at my request. Does not Apply

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* 15. Quality of Care

	Strongly Disagree	Disagree	Agree	Strongly Agree	Does not Apply
I would recommend the services I was provided to my family and friends.	I would recommend the services I was provided to my family and friends. Strongly Disagree	I would recommend the services I was provided to my family and friends. Disagree	I would recommend the services I was provided to my family and friends. Agree	I would recommend the services I was provided to my family and friends. Strongly Agree	I would recommend the services I was provided to my family and friends. Does not Apply
The staff seem educated and competent when providing care.	The staff seem educated and competent when providing care. Strongly Disagree	The staff seem educated and competent when providing care. Disagree	The staff seem educated and competent when providing care. Agree	The staff seem educated and competent when providing care. Strongly Agree	The staff seem educated and competent when providing care. Does not Apply
The staff discussed with me and provided me with relevant and current therapeutic interventions while I was receiving services.	The staff discussed with me and provided me with relevant and current therapeutic interventions while I was receiving services. Strongly Disagree	The staff discussed with me and provided me with relevant and current therapeutic interventions while I was receiving services. Disagree	The staff discussed with me and provided me with relevant and current therapeutic interventions while I was receiving services. Agree	The staff discussed with me and provided me with relevant and current therapeutic interventions while I was receiving services. Strongly Agree	The staff discussed with me and provided me with relevant and current therapeutic interventions while I was receiving services. Does not Apply
The environment and energy of the facility felt welcoming, professional, private, and safe.	The environment and energy of the facility felt welcoming, professional, private, and safe. Strongly Disagree	The environment and energy of the facility felt welcoming, professional, private, and safe. Disagree	The environment and energy of the facility felt welcoming, professional, private, and safe. Agree	The environment and energy of the facility felt welcoming, professional, private, and safe. Strongly Agree	The environment and energy of the facility felt welcoming, professional, private, and safe. Does not Apply
I am encouraged to include family and/or my other support systems when engaging in services.	I am encouraged to include family and/or my other support systems when engaging in services. Strongly Disagree	I am encouraged to include family and/or my other support systems when engaging in services. Disagree	I am encouraged to include family and/or my other support systems when engaging in services. Agree	I am encouraged to include family and/or my other support systems when engaging in services. Strongly Agree	I am encouraged to include family and/or my other support systems when engaging in services. Does not Apply

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* 16. Quality of Life

	Strongly Disagree	Disagree	Agree	Strongly Agree	Does not Apply
My overall Quality of Life has improved since beginning services.	My overall Quality of Life has improved since beginning services. Strongly Disagree	My overall Quality of Life has improved since beginning services. Disagree	My overall Quality of Life has improved since beginning services. Agree	My overall Quality of Life has improved since beginning services. Strongly Agree	My overall Quality of Life has improved since beginning services. Does not Apply
I am doing better in school, work, and/or other daily activities	I am doing better in school, work, and/or other daily activities Strongly Disagree	I am doing better in school, work, and/or other daily activities Disagree	I am doing better in school, work, and/or other daily activities Agree	I am doing better in school, work, and/or other daily activities Strongly Agree	I am doing better in school, work, and/or other daily activities Does not Apply
My personal relationships, family relationships, and/or support system dynamic has improved.	My personal relationships, family relationships, and/or support system dynamic has improved. Strongly Disagree	My personal relationships, family relationships, and/or support system dynamic has improved. Disagree	My personal relationships, family relationships, and/or support system dynamic has improved. Agree	My personal relationships, family relationships, and/or support system dynamic has improved. Strongly Agree	My personal relationships, family relationships, and/or support system dynamic has improved. Does not Apply
I am more self-aware and better at managing my Mental Health needs.	I am more self-aware and better at managing my Mental Health needs. Strongly Disagree	I am more self-aware and better at managing my Mental Health needs. Disagree	I am more self-aware and better at managing my Mental Health needs. Agree	I am more self-aware and better at managing my Mental Health needs. Strongly Agree	I am more self-aware and better at managing my Mental Health needs. Does not Apply

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* 17. Cultural Competency

	Strongly Disagree	Disagree	Agree	Strongly Agree	Does not Apply
My religious or spiritual beliefs and/or practices are respected.	My religious or spiritual beliefs and/or practices are respected. Strongly Disagree	My religious or spiritual beliefs and/or practices are respected. Disagree	My religious or spiritual beliefs and/or practices are respected. Agree	My religious or spiritual beliefs and/or practices are respected. Strongly Agree	My religious or spiritual beliefs and/or practices are respected. Does not Apply
The staff has a professional understanding of my educational, social, socioeconomic, and family background.	The staff has a professional understanding of my educational, social, socioeconomic, and family background. Strongly Disagree	The staff has a professional understanding of my educational, social, socioeconomic, and family background. Disagree	The staff has a professional understanding of my educational, social, socioeconomic, and family background. Agree	The staff has a professional understanding of my educational, social, socioeconomic, and family background. Strongly Agree	The staff has a professional understanding of my educational, social, socioeconomic, and family background. Does not Apply
The staff seemed self-aware, displayed an open attitude including knowledge and skills, and appeared open toward others.	The staff seemed self-aware, displayed an open attitude including knowledge and skills, and appeared open toward others. Strongly Disagree	The staff seemed self-aware, displayed an open attitude including knowledge and skills, and appeared open toward others. Disagree	The staff seemed self-aware, displayed an open attitude including knowledge and skills, and appeared open toward others. Agree	The staff seemed self-aware, displayed an open attitude including knowledge and skills, and appeared open toward others. Strongly Agree	The staff seemed self-aware, displayed an open attitude including knowledge and skills, and appeared open toward others. Does not Apply

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* 18. Accessibility and Technology

	Strongly Disagree	Disagree	Agree	Strongly Agree	Does not Apply
The building and location are easily accessible for my needs.	The building and location are easily accessible for my needs. Strongly Disagree	The building and location are easily accessible for my needs. Disagree	The building and location are easily accessible for my needs. Agree	The building and location are easily accessible for my needs. Strongly Agree	The building and location are easily accessible for my needs. Does not Apply
My request for Reasonable Accommodations was taken seriously and met my needs.	My request for Reasonable Accommodations was taken seriously and met my needs. Strongly Disagree	My request for Reasonable Accommodations was taken seriously and met my needs. Disagree	My request for Reasonable Accommodations was taken seriously and met my needs. Agree	My request for Reasonable Accommodations was taken seriously and met my needs. Strongly Agree	My request for Reasonable Accommodations was taken seriously and met my needs. Does not Apply
Telehealth Services were simple to understand and use.	Telehealth Services were simple to understand and use. Strongly Disagree	Telehealth Services were simple to understand and use. Disagree	Telehealth Services were simple to understand and use. Agree	Telehealth Services were simple to understand and use. Strongly Agree	Telehealth Services were simple to understand and use. Does not Apply
Using the Phone System including Voicemail or ability to contact staff was simple and current with common technology standards	Using the Phone System including Voicemail or ability to contact staff was simple and current with common technology standards Strongly Disagree	Using the Phone System including Voicemail or ability to contact staff was simple and current with common technology standards Disagree	Using the Phone System including Voicemail or ability to contact staff was simple and current with common technology standards Agree	Using the Phone System including Voicemail or ability to contact staff was simple and current with common technology standards Strongly Agree	Using the Phone System including Voicemail or ability to contact staff was simple and current with common technology standards Does not Apply
Searching the website for location, contact information, services available, hours of operation, or performance outcome measures was easily accessible.	Searching the website for location, contact information, services available, hours of operation, or performance outcome measures was easily accessible. Strongly Disagree	Searching the website for location, contact information, services available, hours of operation, or performance outcome measures was easily accessible. Disagree	Searching the website for location, contact information, services available, hours of operation, or performance outcome measures was easily accessible. Agree	Searching the website for location, contact information, services available, hours of operation, or performance outcome measures was easily accessible. Strongly Agree	Searching the website for location, contact information, services available, hours of operation, or performance outcome measures was easily accessible. Does not Apply

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* 19. Health and Safety

	Strongly Disagree	Disagree	Agree	Strongly Agree	Does not Apply
Services are provided in a clean and sanitary facility	Services are provided in a clean and sanitary facility Strongly Disagree	Services are provided in a clean and sanitary facility Disagree	Services are provided in a clean and sanitary facility Agree	Services are provided in a clean and sanitary facility Strongly Agree	Services are provided in a clean and sanitary facility Does not Apply
I believe the organization values my personal health and safety by implementing policies that do NOT permit weapons, tobacco, alcohol, and other illicit or illegal drugs on the premises, at agency-sponsored events, or on an agency-owned property.	I believe the organization values my personal health and safety by implementing policies that do NOT permit weapons, tobacco, alcohol, and other illicit or illegal drugs on the premises, at agency-sponsored events, or on an agency-owned property. Strongly Disagree	I believe the organization values my personal health and safety by implementing policies that do NOT permit weapons, tobacco, alcohol, and other illicit or illegal drugs on the premises, at agency-sponsored events, or on an agency-owned property. Disagree	I believe the organization values my personal health and safety by implementing policies that do NOT permit weapons, tobacco, alcohol, and other illicit or illegal drugs on the premises, at agency-sponsored events, or on an agency-owned property. Agree	I believe the organization values my personal health and safety by implementing policies that do NOT permit weapons, tobacco, alcohol, and other illicit or illegal drugs on the premises, at agency-sponsored events, or on an agency-owned property. Strongly Agree	I believe the organization values my personal health and safety by implementing policies that do NOT permit weapons, tobacco, alcohol, and other illicit or illegal drugs on the premises, at agency-sponsored events, or on an agency-owned property. Does not Apply
In the event of an emergency, while receiving services or while at the facility, I can access health and safety information for safe evacuation or other emergency situations.	In the event of an emergency, while receiving services or while at the facility, I can access health and safety information for safe evacuation or other emergency situations. Strongly Disagree	In the event of an emergency, while receiving services or while at the facility, I can access health and safety information for safe evacuation or other emergency situations. Disagree	In the event of an emergency, while receiving services or while at the facility, I can access health and safety information for safe evacuation or other emergency situations. Agree	In the event of an emergency, while receiving services or while at the facility, I can access health and safety information for safe evacuation or other emergency situations. Strongly Agree	In the event of an emergency, while receiving services or while at the facility, I can access health and safety information for safe evacuation or other emergency situations. Does not Apply

CLIENT SATISFACTION SURVEY- 2023-2024

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* 1. Location

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* 2. What is your gender?

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* 3. Which of the following categories best describes your employment status?

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* 4. Program:

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* 5. Time in Program

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* 6. Living Arrangements

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* 7. What is your age?

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* 8. Health Insurance

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* 9. Access/Admission/Orientation

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* 10. Referrals, Transition and/or Discharge

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* 11. Input from Persons Served

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* 12. Rights and Responsibilities

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* 13. The Assessment Process

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* 14. Treatment Planning

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* 15. Quality of Care

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* 16. Quality of Life

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* 17. Cultural Competency

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* 18. Accessibility and Technology

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* 19. Health and Safety

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* 20. What has been the most helpful thing about the services you received?

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* 21. What would improve the services here?