Port Recovery Program Participant Satisfaction Survey
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Please complete the following information prior to completing the survey
Gender *
Age: *
Race: *
Required
Time in program. *
Survey was completed with help from... *
Program Participant Satisfaction Survey
Please select the number under each item that best represents your option
Assessment/Admission/ Orientation
I got into the program quickly. *
Getting into the program was easy. *
The people who helped me get into the program were nice. *
I understand the program rules and what happens if I don't follow them. *
I understand how the program works. *
Input
People who work here care about what I think. *
I am encouraged to give my opinion about my treatment and this program. *
There are several different wats to offer feedback about the program. *
There are several different wats to offer feedback about the program *
My counselor is interested in what I think about the program. *
I know how my opinion is used to improve the program and services. *
Rights
I am treated with dignity and respect. *
My rights were clearly explained to me *
If something happens that I don't like, I know how to file a complaint *
I have never felt threatened or have been mistreated *
I feel safe when I am in the program *
Assessment
My problems and needs are understood *
When I disclose my problems, I feel safe. *
If I have a new problem or need, there are ways to communicate it to staff. *
I understand why I am asked the questions about my problems. *
when people ask me about my life and my problems, I feel respected. *
Treatment Plan
I know the goals on my treatment plan. *
I helped create the goals on my treatment plan. *
My treatment plan is based on my needs. *
I review my treatment plan on a regular basis. *
I review my treatment plan on a regular basis. *
My treatment plan is changed when things change in my life. *
Quality of Care
I would recommend this program to my family and friends. *
My counselor cares about me. *
My counselor under stand my problems, my needs, and my goals. *
Everyone who works here cares about me. *
I am encouraged to get my family involved in treatment. *
Quality of Life
My life has improved since entering this program. *
I am doing better in school, work, and/or daily activities. *
My family situation has improved. *
I am involved in social situations that support my treatment. *
I am better at handling stress. *
Cultural Competency
My religious and spiritual beliefs/practices are respected. *
The staff has a good understanding of my social and family background. *
I easily understand people speaking to me. *
My beliefs about life and treatment are understood. *
The program is sensitive to people's beliefs and differences. *
Accessibility
The program's building is nice and easy to use. *
The program hours fit my schedule *
The program hours fit my schedule. *
The program location is easy to get to. *
Transportation to and from the program is available and meets my needs. *
The program treats all people equally. *
Client Health and Safety
The organization provides services in a safe setting. *
Services are provided in clean and sanitary facilities. *
I feel safe in the neighborhood and parking area around the organization's facilities. *
I believe the organization values my personal health and safety *
If the facility where I receive services has to be evacuated, I would know where to exit. *
FEEDBACK
Please provide us with comments/feedback about this program
What do we do best?
What is the one area we could most improve
Addition comments
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