Client Satisfaction Survey
Would you like to include your name?
Yes
No
Name
First Name
Last Name
My primary JADE Wellness Center treatment location is:
Monroeville
Wexford
Southside
Brookline - John Ryan's House
AIMS Program
Which type of Serivices do you receive at JWC
Individual Counseling
Group Counseling
CRS Services
MAT / Medication Assisted Treatment
Psychiatric Med Management
Recovery Housing
Individual Counseling
Please rate your overall satisfaction with individual counseling services
Not Satisfied
1
2
3
4
5
6
7
8
9
Very Satisfied
10
1 is Not Satisfied, 10 is Very Satisfied
My therapist spent adequate time with me?
Not Satisfied
1
2
3
4
5
6
7
8
9
Very Satisfied
10
1 is Not Satisfied, 10 is Very Satisfied
Do you feel more equiped to deal with your overall recovery after individual counseling services?
Not Satisfied
1
2
3
4
5
6
7
8
9
Very Satisfied
10
1 is Not Satisfied, 10 is Very Satisfied
Do you wish to specify who you see for individual counseling?
Yes
No
Therapist:
Please provide any feedback regarding your individual counseling:
Group Counseling:
Please rate your overall satisfaction with Group counseling services
Not Satisfied
1
2
3
4
5
6
7
8
9
Very Satisfied
10
1 is Not Satisfied, 10 is Very Satisfied
How would you rate your satisifaction with group preparedness and topics covered?
Not Satisfied
1
2
3
4
5
6
7
8
9
Very Satisfied
10
1 is Not Satisfied, 10 is Very Satisfied
Comfort level regarding group size:
Comfortabl Size
Too big
Too small
N/A
What's your prefered model for group counseling?
Telehealth/Virtual
In-Person
Hybrid(Virtual & Inperson)
N/A
Do you wish to specify who you see for Group counseling?
Yes
No
Group Therapist
Please provide any further comments regarding your group cousneling
Certified Recoery Specialist Services
How helpful was your CRS/Peer Menotr in assisting you to make changes
Not helpful at all
1
2
3
4
5
6
7
8
9
Extremely Helpful
10
1 is Not helpful at all, 10 is Extremely Helpful
Did your CRS encourage you to develop community support?
No encouragement at all
1
2
3
4
5
6
7
8
9
Yes - Strong encouragement
10
1 is No encouragement at all, 10 is Yes - Strong encouragement
Did your CRS assist you with connecting to necessary resources?
No not at all
1
2
3
4
5
6
7
8
9
Yes - significant resource coordination
10
1 is No not at all, 10 is Yes - significant resource coordination
Do you wish to specifiy who you receive peer support services with?
Yes
No
CRS/Peer Support Specialist:
Please provide any further comments regarding your CRS/Peer navigator
MAT/Medication Assisted Treatment
Were you able to see a physician/provider in a timely manner when requested?
Not Satisfied
1
2
3
4
5
6
7
8
9
Very Satisfied
10
1 is Not Satisfied, 10 is Very Satisfied
Satisfaction with personal mannerism of MAT provider (courtesy, respect, sensitivity)
Not Satisfied
1
2
3
4
5
6
7
8
9
Very Satisfied
10
1 is Not Satisfied, 10 is Very Satisfied
I found the provider was helpful?
Strongly Disagree
1
2
3
4
5
6
7
8
9
Stronly agree
10
1 is Strongly Disagree, 10 is Stronly agree
Do you wish to specify who you see for MAT services counseling?
Yes
No
MAT provider
Please provide any further comments regarding your MAT provider
Psychiatric Evaluation and Medication Management
I found the psychiatric/provider easily accessible:
Strongly Disagree
1
2
3
4
5
6
7
8
9
Strongly Agree
10
1 is Strongly Disagree, 10 is Strongly Agree
My psychatist was able to discuss potential side effects thoroughly with me
Strongly disagree
1
2
3
4
5
6
7
8
9
Strongly AGree
10
1 is Strongly disagree, 10 is Strongly AGree
I found the psychiatric/provider overall helpful in treating my mental health symptoms?
Strongly Disagree
1
2
3
4
5
6
7
8
9
Stronly agree
10
1 is Strongly Disagree, 10 is Stronly agree
Do you wish to specify who you see for Psychiatric Med Management services?
Yes
No
Psychiatric provider
Please provide any further comments regarding your Psychiatric provider
Recovery Housing
How satisief are you with the comfort, cleanliness and amentites of the caility?
Strongly Disagree
1
2
3
4
5
6
7
8
9
Strongly Agree
10
1 is Strongly Disagree, 10 is Strongly Agree
I received adequate support in accessing gainful employment, long-term housing and other personal needs
Strongly disagree
1
2
3
4
5
6
7
8
9
Strongly AGree
10
1 is Strongly disagree, 10 is Strongly AGree
The rules and requirements of the house were clearly identified upon entering the house.
Strongly Disagree
1
2
3
4
5
6
7
8
9
Stronly agree
10
1 is Strongly Disagree, 10 is Stronly agree
Additional comments/feedback regarding recovery housing services
Please rate the followings
I do things that are more meaningful to me
1
2
3
4
5
I am better able to take care of my needs
1
2
3
4
5
Kindness of staff members
1
2
3
4
5
I have the support i need from family and friends.
1
2
3
4
5
I feel confident in my recovery
1
2
3
4
5
By considering overall experience with our program , how likely would you recommend to your friends/family?
Not Likely
1
2
3
4
5
6
7
8
9
Very Likely
10
1 is Not Likely, 10 is Very Likely
Please share any additional comments/suggestions
Submit
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