SunServe - Program Participation Survey

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From Email Hidden From Form
example@example.com
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Name of Form Sender Hidden from The Form
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Which of our programs does this survey apply to?* This field is required.You may only choose one program per survey.
Adult Day Care
Housing Case Management
Mental Health
Senior Services/EHEAP
Substance Use Disorder Case Management
Substance Use Disorder Therapy
Support Group(s)
Transgender Services
Women's Services
Youth Services
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Were you treated with respect and courtesy by the SunServe staff?* This field is required.5 = Completely - 1 = Not at all
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Has your participation in SunServe programs improved your access to health and / or support services?* This field is required.5 = Completely - 1 = Not at all
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Was program information presented to you in a manner that was easily understood?* This field is required.5 = Completely - 1 = Not at all
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Did SunServe staff explain your rights as a program participant?* This field is required.5 = Completely - 1 = Not at all
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Did SunServe staff explain your responsibilities as a program participant?* This field is required.5 = Completely - 1 = Not at all
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Were services delivered in a safe environment?* This field is required.5 = Completely - 1 = Not at all
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Were services delivered in a comfortable environment?* This field is required.5 = Completely - 1 = Not at all
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not at all
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How was the overall quality of care that has been provided to you by SunServe?* This field is required.5 = Great- 1 = Poor
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poor
great
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Did you participate in planning your treatment or service goals?* This field is required.5 = Completely - 1 = Not at all
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not at all
completely
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Gender identity...* This field is required.How do you identify?
Female
Male
Non-Binary
Rather not state
There is an option to not answer this question
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Gender identity continued...Do you identify as transgender?
YESNO
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Racial identity...* This field is required.How do you identify?
Asian
Black (African American)
Multiple Races
Pacific Islander
White (Caucasian)
Rather not state
There is an option to not answer this question
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Primary language used?* This field is required.
Creole
English
French
Spanish
All others
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Age range?* This field is required.
02-12
13-17
18-24
25-35
36-45
46-55
56-65
66+
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General comments...All submissions are private and confidential, we never ask for personal contact information
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Agree to submit survey?* This field is required.By clicking submit: I agree to anonymously share feedback about my experience. We will never ask you to reveal your identity during the survey process. If you would like to discuss your experience with a member of management, please feel free to call or email us for a prompt reply. Click yes or no then the submit button to send your anonymous response to our quality assurance department. Phone 954-764-5150 or Email: info@sunserve.org
I agree (select to agree then click submit)
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