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* 1. Which counselor did you see most recently?

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* 2. In the past 6 months, about how many sessions have you had?

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* 3. Have you seen other counselors at EAS/ADAC?

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* 4. Are you 18 or older?

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* 5. How did you hear about us?

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* 6. My calls for information and appointments were returned in a timely manner.

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* 7. I received an appointment reminder prior to my visit.

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* 8. I saw my counselor within 15 minutes of my appointment time.

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* 9. I was treated in a courteous and professional manner by the staff.

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* 10. I found the facility to be orderly, clean and pleasant.

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* 11. My counselor put me at ease so that I could comfortably talk about my concerns.

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* 12. My counselor explained things in a way that was easy to understand.

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* 13. My counselor listened to me and understood my concerns.

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* 14. My counselor showed respect for what I have to say.

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* 15. My counselor was knowledgeable of how to help me.

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* 16. I considered my counselor's advice/instructions.

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* 17. Overall, I am satisfied with the counseling I received.

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* 18. I would seek services here again if needed.

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* 19. I would refer a friend to ADAC/EAS.

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* 20. Please provide any feedback that you feel would help us improve our services.

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