Patient Satisfaction Survey

Patient Name (optional- if you want this to be anonymous please leave blank)

First NameLast Name

Todays Date*

Date

How long were you at the facility*

Who was your individual Therapist for 1 on 1 sessions*

What was the main reason you came to treatment? (Please the most honest answer here is the most helpful)*

Drugs, Alcohol, Trauma, Mental Health, Homeless ETC ETC

What Program did you go through? Check as many as apply*

Did you Graduate or complete treatment as planned.*

Other

1. I am satisfied with the services i've recieved at GMBHC*

	1	2	3	4	5	6	7	8	9	10

1 is Poor, 10 is Excellent

2. The pre-admissions process and getting to treatment was explained and effective?*

	1	2	3	4	5	6	7	8	9	10

1 is Disagree, 10 is Agree

3. Group Therapy Services of the program are useful to my recovery.?*

	1	2	3	4	5	6	7	8	9	10

1 is Disagree, 10 is Agree

4. Individual Therapy Services of the program are useful to my recovery?*

	1	2	3	4	5	6	7	8	9	10

1 is Disagree, 10 is Agree

5. Case Management Services of the program are useful to my recovery.?*

	1	2	3	4	5	6	7	8	9	10

1 is Disagree, 10 is Agree

6. The staff have a good understanding of my problems?*

	1	2	3	4	5	6	7	8	9	10

1 is Disagree, 10 is Agree

7. I worked with staff to decide my treatment goals?*

	1	2	3	4	5	6	7	8	9	10

1 is Disagree, 10 is Agree

8. My rights and responsibilities had been clearly explained to me*

	1	2	3	4	5	6	7	8	9	10

1 is Disagree, 10 is Agree

9. The program(s) are sensitive to people’s different needs and beliefs?*

	1	2	3	4	5	6	7	8	9	10

1 is Disagree, 10 is Agree

10. The issue(s) that I need to address to get and stay sober and/or improve mental health symptoms were addressed in my treatment process?*

	1	2	3	4	5	6	7	8	9	10

1 is Disagree, 10 is Agree

11. Overall I feel I got better as a result of my time in treatment at GMBHC?*

	1	2	3	4	5	6	7	8	9	10

1 is Disagree, 10 is Agree

12. If you could add another aspect to the treatment program, what would it be?*

13. The residential technicians/BHT (direct support staff/Housing) were friendly and effective at improving your experience ?*

	1	2	3	4	5	6	7	8	9	10

1 is Disagree, 10 is Agree

14. What can we do to improve our treatment process and structure for future patients?*

15. Was the Cleanliness of the facility up to your expectations during your stay*

	1	2	3	4	5	6	7	8	9	10

1 is Disagree, 10 is Agree

16. Did you feel safe while traveling in a vehicle with a staff member driving?*

	1	2	3	4	5	6	7	8	9	10

1 is Disagree, 10 is Agree

17. What was the most beneficial aspect of the program at GMBHC for you?*

18. If you had to point out one to two staff members at GMBHC that did a really good job who would it be?

(OPTIONAL QUESTION)

19. Compared to your experience with other behavioral health programs or general overall quality of care, how would you rate GMBHC on a scale of 1-10?*

	1	2	3	4	5	6	7	8	9	10

1 is Low, 10 is Very High

20. How likely are you to recommend GMBHC to a friend or a family member?*

	1	2	3	4	5	6	7	8	9	10

1 is unlikely, 10 is Likely

Additional Comments