Satisfaction Survey - John Ryan's House
Resident Exit Interview Questionnaire
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Full Name
*
First Name
Last Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Admission Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Exit Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Departure
Successfully completed program
Transitioned to independet housing
Transition to another level of care
Leaving before program completion
Resident desired discharge
Other
Section 1: Overall Experience
How would you rate your overall experience at John Ryan's House?
1
2
3
4
5
How supported did you feel by the staff during your stay?
Very Supported
Somewhat Supported
Neutral
Not Supported
Did you feel that John Ryan's House provided a safe, respectful, and recovery-supportive living environment?
Yes
Somewhat
No
What aspects of your experience at John Ryan's House were most helpful to your recovery?
What could we have done differently to improve your experience.
Comments or Special Requests
Please rate on a scale from 1 to 10 the cleanliness of John Ryan's House
1-2 very poor, 3-4 below average, 5-6 Average, 7-8 Good, 9=10 excellent
Section 2: Recovery & Personal Growth
How has your stay at John Ryan's House impacted your recovery?
Significantlly improved my recovery
Somehwat improved my recovery
No significant change
Negatively impacted my recovery
Which services or supports were most beneficial to you? (Select all that apply)
Recovery support staff / CRS
House manager support
Peer relationships and community
Case management and resource assistance
Recovery planning and goal setting
Accountability and house structure
Connection to community recovery meetings
Employment, education, or housing assistance
Other
Do you feel better prepared to maintain your recovery and transition to your next living environment?
Yes
Somewhat
No
Section 3: Environment & Program Quality
How would you rate the following aspects of John Ryan's House?
Rows
Excellent
Good
Fair
Poor
Cleanliness and maintenance
Staff availability and support
House rules and expectations
Respect and dignity
Recovery-focused environment
Support with transition planning
Would you recommended John Ryan's House to someone seeking a supportive recovery residence?
Definitely
Probably
Unsure
No
Is there anything else you would like us to know about your experience?
Section 4: Resident Testimonials (Optional)
We appreciate hearing about the experiences of individuals who have lived at John Ryan’s House. Resident testimonials help others understand our recovery residence and the support available.
Would you be willing to share a testimonial about your experience at John Ryan’s House that may be featured on our website or other promotional materials?
Yes, I would be interested
Maybe, I would like more information
No, thank you
How would you prefer to share your testimonial? (Select all that apply).
Written testimonial - A brief statement about my experience.
Video testimonial - A recorded testimonial sharing my experience.
Unsure - I would like to discuss options with staff.
How would you prefer to be identified if your testimonial is published?
First name only
First name and last initial
Full name
Anonymous (written testimonial only)
I would like to discuss this further
May a staff member contact you to coordinate your testimonial or discuss the testimonial further?
Yes
No
Submit
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