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Please complete the survey below based on the satisfaction with the services.

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* 1. What is your name? (not required to answer)

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* 2. Are you a guardian, client, or referral source?

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* 3. If you are a guardian, how long has your child been in treatment with us?

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* 4. Are you satisfied with communication from your worker?

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* 5. How satisfied are you with your progress since working with A Peace of Mind Wellness?

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* 6. Do you feel that you are treated well by staff?

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* 7. Have you been explained all of the services offered by A Peace of Mind Wellness?

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* 8. Is the facility a comfortable, clean, and easily accessible setting?

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* 9. Are you or were you given the opportunity to express a problem or file a complaint regarding the treatment and/or services?

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* 10. I would rate my overall level of satisfaction with A Peace of Mind Wellness as:

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* 11. Please list three areas of improvement related to your treatment here at A Peace of Mind Wellness.

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* 12. Additional Comments:

THANK YOU for taking time to complete this survey and assist us in making our services the BEST!
Any questions or concerns, please email Jen Fackelman at Jenfackelman@apeaceofmindwellness.com

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