Treasure Health Systems Survey
Participant Satisfaction Survey
Gender *
Age *
Race *
Time In Program *
Survey Was Completed With Help From *
1. I got into the program quickly. *
2. Getting into the program was easy *
3. The people who helped me get into the program were nice. *
4. I understand the program rules and what happens if I don’t follow them. *
5. I understand how the program works *
1. People who work here care about what I think *
2. I am encouraged to give my opinion about my treatment and this program *
3. There are several different ways to offer feedback about the program. *
4. My Therapist, Doctor, or Coordinator is interested in what I think about the program. *
5. I know how my opinion is used to improve the program and services. *
1. I am treated with dignity and respect *
2. My rights were clearly explained to me *
3. If something happens that I don’t like, I know how to file a complaint *
4. I have never felt threatened or have been mistreated *
5. I feel safe when I am in the program *
1. My problems and needs are understood *
2. When I disclose my problems, I feel safe *
3. If I have a new problem or need, there are ways to communicate it to staff *
4. I understand why I am asked questions about my problems *
5. When people ask me about my life and my problems, I feel respected *
Treatment/Rehabilitation Plan
1. I know the goals on my treatment and rehabilitation plan *
2. I helped create the goals on my treatment and rehabilitation plan *
3. My treatment plan is based on my needs *
4. I review my treatment plan on a regular basis. *
5. My treatment plan is changed when things change in my life. *
Quality of Care
1. I would recommend this program to my family and friends. *
2. My coordinator, therapist, and doctor cares about me *
3. My Doctor, therapist, coordinator understands my problems, my needs, and my goals. *
4. Everybody who works here cares about me. *
5. I am encouraged to get my family involved in treatment. *
Quality of Life
1. My life has improved since entering this program. *
2. I am doing better in school, work, and/or daily activities. *
3. My family situation has improved. *
4. I am involved in social situations that support my treatment. *
5. I am better at handling stress. *
Cultural Competency
1. My religious and spiritual beliefs/practices are respected. *
2. The staff has a good understanding of my social and family background. *
3. I easily understand people speaking to me. *
4. My beliefs about life and treatment are understood. *
5. The program is sensitive to people’s beliefs and differences. *
1. The program’s building is nice and is easy to use. *
2. The program hours fit my schedule. *
3. The program location is easy to get to. *
4. Transportation to and from the program is available and meets my needs. *
5. The program treats all people equally. *
Client Health and Safety
1. The organization provides services in a safe setting. *
2. Services are provided in clean and sanitary facilities. *
3. I feel safe in the neighborhood and parking areas around the organization’s facilities. *
4. I believe the organization values my personal health and safety *
5. If the facility where I receive services had to be evacuated, I would know where to exit. *
Please provide us with comments and feedback about this program.
What do we do best? *
What is the one area we could most improve? *
Additional comments: *
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