AIP Client Survey
How would you rate the overall experience of the AIP intake registration process?
Great
Good
Okay
Needs Improvement (please explain below)
Poor (please explain below)
Explain:
How would you describe the overall attitude of the staff providing information and assisting with intake registration?
Attentive
Friendly
Concerned
Distracted
Rushed
Rude
Other (please specify below)
Specify:
How would you rate the overall experience of the AIP intake process?
Great
Good
Okay
Needs Improvement
Poor (please explain below)
Explain:
How would you describe the overall attitude of the staff completing your intake?
Attentive
Friendly
Concerned
Distracted
Rushed
Rude
Other (please specify)
Specify:
How would you describe the overall attitude of your AIP group facilitator(s)?
Attentive
Friendly
Concerned
Rushed
Rude
Other (please specify)
Specify:
My facilitator is meeting my expectations.
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
My facilitator is knowledgeable about the topic being discussed.
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
I feel like group is a safe place to share.
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
The resources in the front area of the AIP office were helpful to me.
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
My facilitator showed genuine concern about myself and other group members.
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
I find the topics discussed in group to be helpful.
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
How would you rate the overall experience of the AIP?
Great
Good
Okay
Needs Improvement (please explain below)
Poor (please explain below)
Explain:
Were you court ordered to this program?
Yes
No
This is my first time in the AIP.
True
False
I have completed my ______ session:
1st-5th
6th-10th
11th-15th
16th-20th
21st-25th
26th-32nd
Overall, I am satisfied with the day and time in which I attend group.
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
Additional comments:
Submit
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