Client Satisfaction Survey

1
Our goal at Life Changes is to support you as you discover recovery and address the needs that brought you to us. In order to find out how we are accomplishing this, we are asking our residents a few questions about the services they received. Please be honest in your answers. Your comments will be held in strict confidence and signing your name is optional. We plan to use your feedback and suggestions to make our services to you, and those coming after you, even better. Thank you for your comments.
2
What is your gender:* This field is required.
Male
Female
Transgender
3
What year were you a resident of Life Changes?* This field is required.2021, 2022, 2023, etc.
4
I was/have been a resident for:* This field is required.
30 days or less
30 days to 60 days
60 days to 90 days
More than 90 days
5
What facility did you live in? * This field is required.address
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6
Please rate the following with 1 representing least satisfied and 5 being most satisfied.
7
Staff treated me with kindness and respect (1 least satisfied/5 most satisfied)* This field is required.
1-Least Satisfied
2
3
4
5-Most Satisfied
8
Staff used terms and language that I understood (1 least satisfied/5 most satisfied)* This field is required.
1-Least Satisfied
2
3
4
5-Most Satisfied
9
Staff assisted me with referrals in a timely manner. (1 least satisfied/5 most satisfied)* This field is required.
1-Least Satisfied
2
3
4
5-Most Satisfied
10
Staff maintained professional conduct and standards. (1 least satisfied/5 most satisfied)* This field is required.
1-Least Satisfied
2
3
4
5-Most Satisfied
11
Staff members were courteous and helpful in meeting my needs. (1 least satisfied/5 most satisfied) * This field is required.
1-Least Satisfied
2
3
4
5-Most Satisfied
12
Staff demonstrated a commitment toward my success. (1 least satisfied/5 most satisfied)* This field is required.
1-Least Satisfied
2
3
4
5-Most Satisfied
13
Please rate whether you agree or disagree with the statements regarding our location and facilities
14
The office location was neat and clean* This field is required.
Agree
Unsure
Disagree
15
The building and facilities were well maintained.* This field is required.
Agree
Unsure
Disagree
16
The temperature and lighting where comfortable.* This field is required.
Agree
Unsure
Disagree
17
Comments?
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18
Please tell us how you rate your services with Life Changes by indicating agree and disagree
19
Intake procedures were completed in an appropriate time* This field is required.
Agree
Unsure
Disagree
20
The rules and expectations of Life Changes were clearly explained to me* This field is required.
Agree
Unsure
Disagree
21
I was provided additional resources when needed* This field is required.
Agree
Unsure
Disagree
22
I am pleased with my overall experience with Life Changes* This field is required.
Agree
Unsure
Disagree
23
I would recommend Life Changes to others* This field is required.
Agree
Unsure
Disagree
24
Additional Comments 1 of 3Please tell us what you liked and found most beneficial from our services/program
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25
Additional Comments 2 of 3What did you like least about the services your received at Life Changes?
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Ok
26
Additional Comments 3 of 3In what ways could our team make your experience better?
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27
NameThis section is optional
Should be Empty: