1.

Thank you for taking time for this survey.  UCS Healthcare utilizes this information to improve performance and services.  The information provided is confidential and only released in a summary format. 

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* 1. Each month, we give away a free UCS Healthcare tshirt to one person who completes our survey. If you want to be entered in the drawing for the tshirt, please provide the following information which remains confidential.  If you don't want to enter the drawing, please skip to question #2. 

 

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* 2. Where do you generally receive services?

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* 3. What services do you receive at UCS Healthcare?  (Mark all that apply)

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* 4. What is your age?

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* 5. How long have you been receiving services?

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* 6. What is your gender?

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* 7. How comfortable/satisfied are you with our physical surroundings (lighting, furniture, cleanliness, ventilation)?

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* 8. How satisfied are you with the hours of operation?

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* 9. Which type of service did you receive during your most recent visit to UCS Healthcare?

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* 10. On the service you received  above, what was your wait time?

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* 11. How satisfied are you with addiction services?

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* 12. How satisfied are you with psychiatric services?

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* 13. How satisfied are you with mental health services?

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* 14. How satisfied are you with physical medical health services?

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* 15. To what degree to you agree with this statement: My treatment providers communicate with each other to improve care.

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* 16. Rate your reaction to this statement:  I am happy with my plan for treatment.

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* 17. How has your overall health (physical and mental) changed as a result of receiving treatment at UCS Healthcare?

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* 18. Rate your reaction to this statement: Groups are scheduled at convenient times.

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* 19. Rate your reaction to this statement: The topics of groups are relevant to my concerns.

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* 20. If UCS Healthcare were to offer more topic specific groups for addiction therapy, which topics would be most beneficial to your treatment?

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* 21. How satisfied are you with the staff (friendly, helpful, knowledgeable)?

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* 22. Who is your primary counselor/therapist/doctor?

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* 23. How satisfied are you with your primary counselor/therapist/doctor?

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* 24. Would you refer our services to a relative/friend?

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* 25. How would you rate your overall experience at UCS Healthcare?

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* 26. Do you have any other feedback you would like to provide?

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