Voluntary and Confidential • Your participation is voluntary. • All feedback received will be kept strictly confidential and will not affect your services at this agency. • This agency’s staff will NOT have access to your individual responses. Only authorized personnel from the Quality Assurance Department will see your answers. • If you prefer to complete this survey at a later time, please ask your therapist/provider for a paper survey and a prepaid return envelope, and mail your completed survey to us.