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* 1. Date of questionnaire:

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* 2. How long were you part of the program:

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* 3. Age

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* 4. Gender :

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* 5. Language preferred

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* 6. I felt involved as much as I wanted to be in decisions about my treatment services and supports.

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* 7. I am better able to manage difficulties than before starting the program.

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* 8. The service I received allowed me to meet my goals.

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* 9. The worker was able to effectively communicate with me in the official language of my choice

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* 10. My culture was respected and taken into consideration by the worker.

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* 11. I found the worker knowledgeable and competent.

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* 12. If I had a concern, I would know how to make a complaint to this organization.

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* 13. I was assured that my personal information was kept safe and secure.

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* 14. Please comment on aspects of your experience with this program that were particularly helpful to you.

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* 15. Please comment on aspects of your experience with this program that you feel could be improved or changed.

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* 16. Additional Comments:

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