Client Satisfaction Survey

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* 1. Which program did you attend?

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* 2. Please indicate your experience with the following:

	Poor	Fair	Good	Very Good	Excellent
Overall experience at the program	Overall experience at the program Poor	Overall experience at the program Fair	Overall experience at the program Good	Overall experience at the program Very Good	Overall experience at the program Excellent
Professionalism of staff	Professionalism of staff Poor	Professionalism of staff Fair	Professionalism of staff Good	Professionalism of staff Very Good	Professionalism of staff Excellent

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* 3. The care I received from the following staff member was:

	Poor	Fair	Good	Very Good	Excellent	N/A
Primary Therapist	Primary Therapist Poor	Primary Therapist Fair	Primary Therapist Good	Primary Therapist Very Good	Primary Therapist Excellent	Primary Therapist N/A
Nursing Team	Nursing Team Poor	Nursing Team Fair	Nursing Team Good	Nursing Team Very Good	Nursing Team Excellent	Nursing Team N/A
Recovery Coaches/BHTs/MHCs	Recovery Coaches/BHTs/MHCs Poor	Recovery Coaches/BHTs/MHCs Fair	Recovery Coaches/BHTs/MHCs Good	Recovery Coaches/BHTs/MHCs Very Good	Recovery Coaches/BHTs/MHCs Excellent	Recovery Coaches/BHTs/MHCs N/A
Medical Provider	Medical Provider Poor	Medical Provider Fair	Medical Provider Good	Medical Provider Very Good	Medical Provider Excellent	Medical Provider N/A
Psychiatric Provider	Psychiatric Provider Poor	Psychiatric Provider Fair	Psychiatric Provider Good	Psychiatric Provider Very Good	Psychiatric Provider Excellent	Psychiatric Provider N/A
Dietitian	Dietitian Poor	Dietitian Fair	Dietitian Good	Dietitian Very Good	Dietitian Excellent	Dietitian N/A
Chef	Chef Poor	Chef Fair	Chef Good	Chef Very Good	Chef Excellent	Chef N/A
Clinical/Program Director	Clinical/Program Director Poor	Clinical/Program Director Fair	Clinical/Program Director Good	Clinical/Program Director Very Good	Clinical/Program Director Excellent	Clinical/Program Director N/A

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* 4. Please rate the following statements about the clinical program:

	Strongly Disagree	Somewhat Disagree	Neither Agree nor Disagree	Somewhat Agree	Strongly Agree	N/A
I was asked about my treatment goals and needs.	I was asked about my treatment goals and needs. Strongly Disagree	I was asked about my treatment goals and needs. Somewhat Disagree	I was asked about my treatment goals and needs. Neither Agree nor Disagree	I was asked about my treatment goals and needs. Somewhat Agree	I was asked about my treatment goals and needs. Strongly Agree	I was asked about my treatment goals and needs. N/A
I developed the skills I need to eat independently.	I developed the skills I need to eat independently. Strongly Disagree	I developed the skills I need to eat independently. Somewhat Disagree	I developed the skills I need to eat independently. Neither Agree nor Disagree	I developed the skills I need to eat independently. Somewhat Agree	I developed the skills I need to eat independently. Strongly Agree	I developed the skills I need to eat independently. N/A
I developed specific skills to challenge the eating disorder thoughts and behaviors.	I developed specific skills to challenge the eating disorder thoughts and behaviors. Strongly Disagree	I developed specific skills to challenge the eating disorder thoughts and behaviors. Somewhat Disagree	I developed specific skills to challenge the eating disorder thoughts and behaviors. Neither Agree nor Disagree	I developed specific skills to challenge the eating disorder thoughts and behaviors. Somewhat Agree	I developed specific skills to challenge the eating disorder thoughts and behaviors. Strongly Agree	I developed specific skills to challenge the eating disorder thoughts and behaviors. N/A
My treatment goals and needs were met.	My treatment goals and needs were met. Strongly Disagree	My treatment goals and needs were met. Somewhat Disagree	My treatment goals and needs were met. Neither Agree nor Disagree	My treatment goals and needs were met. Somewhat Agree	My treatment goals and needs were met. Strongly Agree	My treatment goals and needs were met. N/A
Family therapy was effective.	Family therapy was effective. Strongly Disagree	Family therapy was effective. Somewhat Disagree	Family therapy was effective. Neither Agree nor Disagree	Family therapy was effective. Somewhat Agree	Family therapy was effective. Strongly Agree	Family therapy was effective. N/A
Group therapy was effective.	Group therapy was effective. Strongly Disagree	Group therapy was effective. Somewhat Disagree	Group therapy was effective. Neither Agree nor Disagree	Group therapy was effective. Somewhat Agree	Group therapy was effective. Strongly Agree	Group therapy was effective. N/A
The program helped me understand the underlying causes of my eating disorder.	The program helped me understand the underlying causes of my eating disorder. Strongly Disagree	The program helped me understand the underlying causes of my eating disorder. Somewhat Disagree	The program helped me understand the underlying causes of my eating disorder. Neither Agree nor Disagree	The program helped me understand the underlying causes of my eating disorder. Somewhat Agree	The program helped me understand the underlying causes of my eating disorder. Strongly Agree	The program helped me understand the underlying causes of my eating disorder. N/A

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* 5. Please rate the following statements about the environment:

	Strongly Disagree	Somewhat Disagree	Neither Agree nor Disagree	Somewhat Agree	Strongly Agree	N/A
I felt safe in the program.	I felt safe in the program. Strongly Disagree	I felt safe in the program. Somewhat Disagree	I felt safe in the program. Neither Agree nor Disagree	I felt safe in the program. Somewhat Agree	I felt safe in the program. Strongly Agree	I felt safe in the program. N/A
The facility was clean, comfortable, and appropriate.	The facility was clean, comfortable, and appropriate. Strongly Disagree	The facility was clean, comfortable, and appropriate. Somewhat Disagree	The facility was clean, comfortable, and appropriate. Neither Agree nor Disagree	The facility was clean, comfortable, and appropriate. Somewhat Agree	The facility was clean, comfortable, and appropriate. Strongly Agree	The facility was clean, comfortable, and appropriate. N/A
I experienced the program as a trauma-informed care environment.	I experienced the program as a trauma-informed care environment. Strongly Disagree	I experienced the program as a trauma-informed care environment. Somewhat Disagree	I experienced the program as a trauma-informed care environment. Neither Agree nor Disagree	I experienced the program as a trauma-informed care environment. Somewhat Agree	I experienced the program as a trauma-informed care environment. Strongly Agree	I experienced the program as a trauma-informed care environment. N/A

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* 6. Please rate the following statements about the admission, discharge, and aftercare plans:

	Strongly Disagree	Somewhat Disagree	Neither Agree nor Disagree	Somewhat Agree	Strongly Agree
I had a positive experience with the admissions process prior to my arrival at the program.	I had a positive experience with the admissions process prior to my arrival at the program. Strongly Disagree	I had a positive experience with the admissions process prior to my arrival at the program. Somewhat Disagree	I had a positive experience with the admissions process prior to my arrival at the program. Neither Agree nor Disagree	I had a positive experience with the admissions process prior to my arrival at the program. Somewhat Agree	I had a positive experience with the admissions process prior to my arrival at the program. Strongly Agree
My aftercare plan gives me the tools I need to continue my treatment and recovery.	My aftercare plan gives me the tools I need to continue my treatment and recovery. Strongly Disagree	My aftercare plan gives me the tools I need to continue my treatment and recovery. Somewhat Disagree	My aftercare plan gives me the tools I need to continue my treatment and recovery. Neither Agree nor Disagree	My aftercare plan gives me the tools I need to continue my treatment and recovery. Somewhat Agree	My aftercare plan gives me the tools I need to continue my treatment and recovery. Strongly Agree

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* 7. The part of my treatment that was most meaningful was:

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* 8. How can we improve our program? (Safety, environment, clinical programming, etc.)

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* 9. The staff members who positively impacted my treatment experience the most were:

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* 10. How likely is it that you would recommend this program to a friend or colleague?

NOT AT ALL LIKELY

EXTREMELY LIKELY

0

1

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5

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9

10

0

1

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10

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* 11. I give permission to anonymously share this review of my treatment experience with others, with the intention being to help potential clients make the right decision about attending this program

Yes

No