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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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My primary JADE Wellness Center treatment location is:
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Please rate your overall satisfaction with treatment experience. *
Not at all satisfied
Extremely satisfied
How likely would you be to recommend this agency to a family member or friend?
Not ay all likely
Extremely likely
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How satisfied are you with the manners of the person(s) who scheduled your appointment?
Not at all satisfied
Extremely satisfied
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Was the reception staff helpful and courteous?
Not at all helpful and courteous
Extremely helpful and courteous
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Any further  comments?
The how satisfied are you with the comfort, cleanliness and amenities of the facility?
Not at all satisfied
Extremely satisfied
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What is your preferred model for group sessions:
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What is your preferred model for 1:1 sessions:
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Comfort level regarding group size:
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Further comments:
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
Extremely quickly
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Were the wait times for your appointments acceptable?
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In time of crisis, could the staff be easily contacted?
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Further Comments:
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
Extremely comfortable
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Did you feel free to complain?
Not at all
Yes - Very much so
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Did you feel your treatment was individualized to you?
Not at all
Yes - Very much so
Clear selection
Medical Services
Please indicate your level of satisfaction with the following items.
Did you receive Med Management Services?
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Who was your primary provider?
Were you able to see a physician/provider in a timely manner when requested?
No - it took far too long
Yes - was able to be seen quickly
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His/her personal manner (courtesy, respect, sensitivity, friendliness)
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I found the physician/provider was helpful.
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If lab work was done, did you receive your lab results in a timely manner following your visit.
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Comments regarding physician/provider services:
Who was your nurse:
Did you find the nurse(s) to be helpful?
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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?
My therapist spent adequate time with me.
Strongly disagree
Strongly agree
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His/Her personal mannerism (courtesy, respect, friendliness, sensitivity)
Very dissatisfied
Extremely satisfied
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It was easy to contact my therapist when needed.
Strongly Disagree
Strongly Agree
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My therapist was helpful to my overall recovery.
Strongly Disagree
Strongly Agree
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Additional comments pertaining to my primary therapist:
Did you utilize Peer Services (CRS) while engaged in treatment?
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Who was your Peer Support/CRS specialist?
How helpful was your CRS/Peer Mentor in assisting you to make changes?  
Not at all helpful
Extremely helpful
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Did the staff encourage you to develop community support?
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Additional CRS comments/quality:
Intake and administrative
Please indicate your level of satisfaction with the following questions:
Was your initial assessment / first appointment helpful?
Not at all helpful
Extremely helpful
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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
Yes - I was very comfortable upon admission to treatment
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Additional comments regarding initial assessment/admission to treatment:
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
Strongly agree
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I am better able to take care of my needs.
Strongly disagree
Strongly agree
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In a crisis, I would have the support I need from family and friends.
Strongly disagree
Strongly agree
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I do better in social situations.
Strongly disagree
Strongly agree
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Do you have any other suggestions for improvements our services?
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