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Outpatient Services

Client/Family Satisfaction Survey

In order to improve the quality of our program and to help us meet your needs as well as the needs of other client's, we would like your feedback. Your opinion is valued and greatly appreciated

Rating Scale


N/A - Not Application

1 - Poor

2 - Fair

3 - Good

4 - Very Good

5 - Excellent


Full Name
0/50

Staff Relations
Level of Courtesy shown by staff to you, family and caregiver.
Willingness of Psychiatrist's response to your needs.
Willingness of Nursing staff's response to your needs.
Willingness of Therapist's response to your needs.
How well did the staff honor your privacy and confidentiality?

Program Treatment
How well did the staff explain the reasons for your admission?
Staff's assistance in helping you understand treatment goal.
How well were the program rules and client rights explained to you?
How well did the staff involve you and your family in treatment process?
Satisfaction with explanation of medications, including what to expect.
Staff's discussion with you or family regarding discharge plans/instructions.
How much have you been helped by attending this program?

Overall Rating
How would you rate the program overall?
If you need to be in treatment again, would you return to this facility?
Would you refer family or friends to this program?
Please give us suggestions for improving our program.
0/500
Is there any staff member you would like to recognize for going above and beyond?
0/500
Submit Survey
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