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Client Entrance Survey

Please help our agency make services better by answering some questions about the services you received.  Your answers are confidential and will not influence the services you receive.  Put a cross (X) in the box that best describes your answer. Thank you!!!
1.Location(Required.)
2.Admitted Program or Cancelled Appointment(Required.)
3.What is your gender?(Required.)
4.Which of the following categories best describes your employment status?(Required.)
5.Living Arrangements(Required.)
6.What is your age?(Required.)
7.Health Insurance(Required.)
8.Please choose the best answer to describe your experience.(Required.)
Strongly Disagree
Disagree
Undecided
Agree
Strongly Agree
I am satisfied with the referral process
It was easy to find the facility.
The staff did a good job in reference to customer service.
I received feedback from staff regarding services quickly
All of my questions were answered during intake.
I feel safe in the environment
I am likely to recommend your organization to someone needing services.
I have been treated with dignity and respect.
I am satisfied with the program orientation.
My expectations in reference to admission were fully met.
9.What has been the most helpful thing about the services you received during the assessment process?        
10.What would improve the services here?
Current Progress,
0 of 10 answered