X hits on this document

PDF document

Diane Rae Davis, PhD and Amber Cleverly, MSW - page 79 / 80

178 views

0 shares

0 downloads

0 comments

79 / 80

APPENDIX D. CONSUMER SATISFACTION SURVEY

Consumer Satisfaction Form

Idaho PreTreatment Grant Project

Today’s date Instructions:

_________________

Please answer each item by circling one response for each statement. An envelope will be provided you to mail to the Project Evaluator. Thank you for helping us serve you and others better in the future.

1. Having a person help me find a treatment program that fits my needs was helpful.

Strongly agree

Agree

Disagree

Strongly Disagree

Don’t know

2. Having a person to talk to while I waited to get into treatment was helpful.

Strongly agree

Agree

Disagree

Strongly Disagree

Don’t know

3. Tracking my own stage of change at the end of every meeting helped me make

a good decision about treatment.

Strongly agree

Agree

Disagree

Strongly Disagree

Don’t know

4. Setting weekly goals that support my children and myself was helpful.

Strongly agree

Agree

Disagree

Strongly Disagree

Don’t know

5. If I could change anything about the program I would change ________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

6. Other comments:

____________________________________________________

__________________________________________________________________

This form will be mailed to: Diane Davis, PhD. Evaluator, Pretreatment Program School of Social Work Eastern Washington University

78

Document info
Document views178
Page views178
Page last viewedSun Dec 04 18:56:14 UTC 2016
Pages80
Paragraphs2133
Words26225

Comments