Client Satisfaction Survey
Answer the questions that apply to you and share any suggestions for improvement.
Overall, how satisfied are you with the services you received from the program?
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
Do you feel respected and treated with dignity by staff?
Always
Usually
Sometimes
Rarely
Never
Do you feel safe when participating in the program or visiting the facility?
Always
Usually
Sometimes
Rarely
Never
How well do staff listen to your concerns and involve you in your treatment or recovery plan?
Excellent
Good
Fair
Poor
Very Poor
Have the services helped you make progress toward your personal recovery goals?
A Great Deal
Somewhat
A Little
Not Yet
Not Applicable
How satisfied are you with communication about appointments, services, and treatment?
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
Do the skills and resources provided help you better manage your mental health and daily living?
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
How likely are you to recommend this program to someone who could benefit from mental health services?
Very Likely
Likely
Not Sure
Unlikely
Very Unlikely
What do you like most about our program?
What suggestions do you have to improve our services?
Contact Information (optional)
Full Name
First Name
Last Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Method of Contact
Phone
Email
No Preference
Best Time to Contact You:
Mornings 8am - 11am
Afternoon 12pm - 3pm
Evening 4pm - 6pm
No Preference
Submit Survey
Should be Empty: