Step 1 of 2 50% Date Survey Completed:(Required) MM slash DD slash YYYY Client Name: First Last Programs:(Required) Mental Health Medication Management Psychiatric Rehabilitation Substance Use Contact Type:(Required)Phone/VideoIn-PersonSelf-ReportedNot able to contact To What Extent did the Counselor:Help you achieve the purpose of which you sought services?(Required)Not At AllSometimesNeutralMost of the TimeCompletelyHelp you obtain skills that will help you handle future problems?(Required)Not At AllSometimesNeutralMost of the TimeCompletelyShow interest in your needs?(Required)Not At AllSometimesNeutralMost of the TimeCompletelyEducated you about aspects of your substance abuse/dependence/mental illness/wellness?(Required)Not At AllSometimesNeutralMost of the TimeCompletelyUnderstands your needs?(Required)Not At AllSometimesNeutralMost of the TimeCompletelyInvolve you in the Treatment Planning Process? (such as treatment goals/appointments/etc)(Required)Not At AllSometimesNeutralMost of the TimeCompletelyRespond to your requests for services and/or link you to additional services?(Required)Not At AllSometimesNeutralMost of the TimeCompletelyHow would you rate our intake process?N/A. Did not complete an intake.Easy (5)Somewhat Easy (4)Somewhat Hard (3)Hard (2)Super Hard (1)Are you willing to continue to services with our agency??(Required)YesNoWhy?Do you have any specific concerns about your treatment?(Required)YesNoWhy?Are there things you feel were especially good or helpful about your treatment?(Required)YesNoWhy?General Feedback: