Please tell us about your experience with ACTS.

Please help us by answering some questions about the services that you are receiving. Your feedback is very important to us and will be used confidentially to assist us in providing the best services possible. 

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* 1. Todays date?

Enter date.

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* 2. Please select the program where you are receiving services.

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* 3. Please rate the services you are receiving.

  Strongly Agree Agree Neutral Disagree Strongly Disagree
1. I understand the role of ACTS staff.
2. ACTS staff treat me with courtesy and respect.
3. ACTS staff are knowledgeable about community resources.
4. I believe that ACTS staff are sensitive to my unique needs and supportive of my well-being.
5. I believe I am making progress towards my goals.
6. ACTS staff provide me with information about other services that are available to me.
7. ACTS staff listen to my ideas and involve me in decision making.
8. I feel safe in my home/program.
9. Overall, I am satisfied with the services I am receiving.

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* 4. If you have experienced a situation where ACTS staff have gone "out of their way" to help you, please explain how and who.

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* 5. Additional comments and/or suggestions.

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