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* 1. Did staff introduce themselves to you before providing care?

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* 2. Did you feel that you were treated with respect and dignity during your outpatient visit?

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* 3. Were you or your caregiver asked what your NEEDS or CULTURAL values are when making decisions about your care?
(Your unique needs, customs, beliefs, rituals, traditions, such as any or all of the following: accessibility needs; dietary restrictions such as gluten-free, vegetarian, etc.; interpreter assistance for all languages; family members or close friends present; visits by clergy members, elders, or spiritual leaders; visits to the multi-denominational chapel; access to the traditional ceremonial room; traditional healing options; sacraments or sacred rituals; who you would like to make decisions about your care if not you, etc.)

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* 4. If you had any questions or concerns regarding your condition or treatment, did the staff discuss them with you?

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* 5. Did you receive enough information from hospital staff about what to do if you were worried about your condition or treatment after you left the hospital?

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* 6. In general, how confident are you that you know what to do to take care of and manage your substance use and/or mental health?

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* 7. Did we address your anxiety and fears in a way that you felt cared for?

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* 8. Would you recommend Outpatient Withdrawal Services to family and friends?

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* 9. Do you feel that coming to Outpatient Withdrawal Services helped you?

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* 10. What group topics did you find helpful during your stay?

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* 11. Were recreational activities and outings meaningful and enjoyable?

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* 12. Is there anyone you would like to recognize for the care he or she provided during your stay?

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* 13. Are there any general comments you would like to share?

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* 14. Is there any feedback for improvement that you would like to provide?

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