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Participants Satisfaction Survey

Choice Health Systems Survey

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Gender
Age
Race
Time In Program
Survey Was Completed With Help From

Access/Admission/Orientation

1. I got into the program quickly.
2. Getting into the program was easy
3. The people who helped me get into the program were nice.
4. I understand the program rules and what happens if I don’t follow them.
5. I understand how the program works

Input

1. People who work here care about what I think
2. I am encouraged to give my opinion about my treatment and this program
3. There are several different ways to offer feedback about the program.
4. My Therapist, Doctor, or Coordinator is interested in what I think about the program.
5. I know how my opinion is used to improve the program and services.

Rights

1. I am treated with dignity and respect
2. My rights were clearly explained to me
3. If something happens that I don’t like, I know how to file a complaint
4. I have never felt threatened or have been mistreated
5. I feel safe when I am in the program

Assessment

1. My problems and needs are understood
2. When I disclose my problems, I feel safe
3. If I have a new problem or need, there are ways to communicate it to staff
4. I understand why I am asked questions about my problems
5. When people ask me about my life and my problems, I feel respected

Treatment/Rehabilitation Plan

1. I know the goals on my treatment and rehabilitation plan
2. I helped create the goals on my treatment and rehabilitation plan
3. My treatment plan is based on my needs
4. I review my treatment plan on a regular basis.
5. My treatment plan is changed when things change in my life.

Quality of Care

1. I would recommend this program to my family and friends.
2. My coordinator, therapist, and doctor cares about me
3. My Doctor, therapist, coordinator understands my problems, my needs, and my goals.
4. Everybody who works here cares about me.
5. I am encouraged to get my family involved in treatment.

Quality of Life

1. My life has improved since entering this program.
2. I am doing better in school, work, and/or daily activities.
3. My family situation has improved.
4. I am involved in social situations that support my treatment.
5. I am better at handling stress.

Cultural Competency

1. My religious and spiritual beliefs/practices are respected.
2. The staff has a good understanding of my social and family background.
2. The staff has a good understanding of my social and family background. (copy)
3. I easily understand people speaking to me.
4. My beliefs about life and treatment are understood.
5. The program is sensitive to people’s beliefs and differences.

Accessibility

1. The program’s building is nice and is easy to use.
2. The program hours fit my schedule.
3. The program location is easy to get to.
4. Transportation to and from the program is available and meets my needs.
5. The program treats all people equally.

Client Health and Safety

1. The organization provides services in a safe setting.
2. Services are provided in clean and sanitary facilities.
3. I feel safe in the neighborhood and parking areas around the organization’s facilities.
4. I believe the organization values my personal health and safety
5. If the facility where I receive services had to be evacuated, I would know where to exit.

Please provide us with comments and feedback about this program.

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