NAMI Living Room Program Survey

NAMI Recovery Support Survey

Thank you for taking a few minutes to take this survey. Your participation is crucial in order for us to receive our funding!
Overall Evaluation
Select any programs you have participated in during the last three months:*

Drop-In CenterConnections Support GroupFamily Support GroupLiving Room Program
On a scale of 1-5, how well did the program/service meet your expectations? (1 = Below Expectations and 5 = Above Expectations)*

1

2

3

4

5

1 is Below Expectations, 5 is Above Expectations
On a scale of 1-5, how satisfied are you with this program/service? (1 = Extremely Unsatisfied and 5 = Extremely Satisfied)*

1

2

3

4

5

1 is Extremely Unsatisfied, 5 is Extremely Satisfied
On a scale of 1-5, how valuable is this program/service in your life? (1 = Not Valuable at All and 5 = Extremely Valuable)*

1

2

3

4

5

1 is Not Valuable, 5 is Extremely Valuable
Increased Knowledge & Functioning
I learned something new from this experience that I didn’t know before*

1

2

3

4

5

1 is Strongly Disagree, 5 is Strongly Agree
I am better prepared to meet my needs or the needs of my family member after this experience*

1

2

3

4

5

1 is Strongly Disagree, 5 is Strongly Agree
Feeling nervous anxious, or on edge*
Not being able to stop worrying or controlling your thoughts*
Lack of interest in doing things*
Feeling sad or depressed*
Thinking about ending your life*
Living Room Guests Only: Where would you have gone or what would you have done if you did not come to the Living Room Program today?
Other Feedback
Please list any other comments here about what you liked, or how we can improve this program/service (optional):
Type first initial, last name, and DOB to sign the document*
Example: John Smith with birthday 01/01/1992 would type "jsmith01011992"
Should be Empty:

NAMI Recovery Support Survey

Overall Evaluation

Increased Knowledge & Functioning

Other Feedback