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Client Survey
Please indicate your level of satisfaction with the following items.
Use the scale below with a 5 being Very Satisfied and 1 Being Not at all satisfied.
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Email
*
Your email
I attend treatment at:
JADE Wellness Center
Journey Healthcare
Clear selection
My primary treatment location is:
Monroeville
Wexford
Southside
Robinson
Murrysville
Clear selection
Please rate your overall satisfaction with treatment experience.
*
Not at all satisfied
1
2
3
4
5
Extremely satisfied
How likely would you be to recommend this agency to a family member or friend?
Not ay all likely
1
2
3
4
5
Extremely likely
Clear selection
How satisfied are you with getting through to the office by phone?
Not at all satisfied
1
2
3
4
5
Extremely satisfied
Clear selection
How satisfied are you with the manners of the person(s) who scheduled your appointment?
Not at all satisfied
1
2
3
4
5
Extremely satisfied
Clear selection
Was the reception staff helpful and courteous?
Not at all helpful and courteous
1
2
3
4
5
Extremely helpful and courteous
Clear selection
Any further comments?
Your answer
Response to Covid-19 Pandemic
Please indicate your level of satisfaction with the following items.
The how satisfied are you with the comfort, cleanliness and amenities of the facility?
Not at all satisfied
1
2
3
4
5
Extremely satisfied
Clear selection
How satisfied are you with the perceived sense of safety attending treatment in person?
Not at all satisfied
1
2
3
4
5
Extremely satisfied
Clear selection
What is your preferred model for group sessions:
Telehealth/Virtual
In-Person
Blended/Hybrid (Some members in person, others Virtual)
N/A
Clear selection
What is your preferred model for Individual sessions:
Telehealth/Virtual
In-Person
N/A
Clear selection
Comfort level regarding group size:
Comfortable Size
Too big
Too small
N/A
Clear selection
Further comments:
Your answer
Access to Treatment:
Please indicate your level of satisfaction with the following items.
After initial contact, I could get in for an initial appointment / assessment quickly.
Not quickly at all
1
2
3
4
5
Extremely quickly
Clear selection
Were the wait times for your appointments acceptable?
Yes - the wait times were under 15 minutes
Kind of - they were approximately 30 minutes
Not really - they were about 45 minutes
No - they were about an hour
Other:
Clear selection
In time of crisis, could the staff be easily contacted?
Yes
No
N/A
Other:
Clear selection
Further Comments:
Your answer
Treatment Planning, Quality of Care
Please indicate your level of satisfaction with the following items.
Did you feel comfortable asking questions about your treatment?
Not comfortable at all
1
2
3
4
5
Extremely comfortable
Clear selection
Did you feel free to complain?
Not at all
1
2
3
4
5
Yes - Very much so
Clear selection
Did you feel your treatment was individualized to you?
Not at all
1
2
3
4
5
Yes - Very much so
Clear selection
Medical Services
Please indicate your level of satisfaction with the following items.
Did you receive Med Management Services?
Yes
No
Clear selection
Who was your primary provider?
Dr. Allen
Dr. Goszinski
Dr. Woolhandler
Allie Palm
Dr. Lutka
Dr. Matasy
Sasha Zeleznik
Chelsey Smail
Joann Chmielewski
Danielle Dipre
Maria Wunderley
N/A
Unknown
Were you able to see a physician/provider in a timely manner when requested?
No - It took far too long
No - it took longer than I would have liked.
Neutral
Yes - it was fairly quick
Yes - It was very timely
N/A
Clear selection
His/her personal manner (courtesy, respect, sensitivity, friendliness)
Very unsatisfied
Moderately unsatisfied
Neurtral
Moderately satisfied
Very satisfied
N/A
Clear selection
I found the physician/provider was helpful.
Strongly Agree
Moderately Agree
Neutral
Disagree
Strongly Disagree
N/A
Clear selection
If lab work was done, did you receive your lab results in a timely manner following your visit.
Yes
No
N/A
Other:
Clear selection
Comments regarding physician/provider services:
Your answer
Who was your nurse:
Yasmine Oden
Gloria Menotiades
Kate Mason
Sandy Blystone
Leah Weiss
N/A
Other:
Did you find the nurse(s) to be helpful?
Yes
No
N/A
Other:
Clear selection
Who was your Medical Assistant:
Candy Montoya
Stephanie Coleman
N/A
Other:
Did you find the Medical Assistant(s) to be helpful?
Yes
No
N/A
Clear selection
Quality of Services & Specificity of Services provided
Please rate the quality of services you received and your overall satisfaction with services provided.
Who was/is your primary therapist?
Your answer
My therapist spent adequate time with me.
Strongly disagree
1
2
3
4
5
Strongly agree
Clear selection
His/Her personal mannerism (courtesy, respect, friendliness, sensitivity)
Very dissatisfied
1
2
3
4
5
Extremely satisfied
Clear selection
It was easy to contact my therapist when needed.
Strongly Disagree
1
2
3
4
5
Strongly Agree
Clear selection
My therapist was helpful to my overall recovery.
Strongly Disagree
1
2
3
4
5
Strongly Agree
Clear selection
Additional comments pertaining to my primary therapist:
Your answer
Did you utilize Peer Services (CRS) while engaged in treatment?
Yes
No
I'm not sure what CRS (Peer Support) services are
N/A
Clear selection
Who was your Peer Support/CRS specialist?
Sandy Salensky
Devin Finley
Sheridan Woika
N/A
Other:
How helpful was your CRS/Peer Mentor in assisting you to make changes?
Not at all helpful
1
2
3
4
5
Extremely helpful
Clear selection
Additional staff quality:
Did the staff encourage you to develop community support?
Yes - Strong encouragement
Moderately - Some encouragement
No - Minimal to no encouragement
N/A
Other:
Clear selection
Overall, did you feel you were treated with respect?
Not at all
1
2
3
4
5
Yes, Absolutely
Clear selection
Intake and administrative
Please indicate your level of satisfaction with the following questions:
Was your initial assessment / first appointment helpful?
Not at all helpful
1
2
3
4
5
Extremely helpful
Clear selection
Did you receive information regarding the program and feel comfortable about admission to treatment?
No - I did not feel comfortable about the treatment process upon admission
1
2
3
4
5
Yes - I was very comfortable upon admission to treatment
Clear selection
Additional comments regarding initial assessment/admission to treatment:
Your answer
Social Connectedness
Please indicate how you’ve progressed in the following areas since the onset of treatment.
I do things that are more meaningful to me.
Strongly disagree
1
2
3
4
5
Strongly agree
Clear selection
I am better able to take care of my needs.
Strongly disagree
1
2
3
4
5
Strongly agree
Clear selection
I am happy with the friendships I have.
Strongly disagree
1
2
3
4
5
Strongly agree
Clear selection
In a crisis, I would have the support I need from family and friends.
Strongly disagree
1
2
3
4
5
Strongly agree
Clear selection
I do better in social situations.
Strongly disagree
1
2
3
4
5
Strongly agree
Clear selection
I get along better with my family.
Strongly disagree
1
2
3
4
5
Strongly agree
Clear selection
Do you have any other suggestions for improvements our services?
Your answer
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