CLIENT SATISFACTION SURVEY

Your opinion about the quality of service you have received from Rim Family Services, Inc. is important to us. Thank you for completing this survey.

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* 1. My initial phone call was answered promptly and politely.

Yes

N/A

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* 2. I participated in the following program(s):

Community Event

DUI/PC1000

Groups (Support, Education, Etc.)

Therapy/Counseling

Other (please specify)

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* 3. The location of my program/service was convenient for me.

Yes

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* 4. On my first contact with RFS, I was greeted promptly and politely.

Yes

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* 5. Ethnic background (response is optional).

Caucasian

Native American

African American

Hispanic/Latino

Asian

Other (please specify)

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* 6. Services Received

	Yes	No
I was able to obtain all the services I needed.	I was able to obtain all the services I needed. Yes	I was able to obtain all the services I needed. No
Staff believed I could grow and change.	Staff believed I could grow and change. Yes	Staff believed I could grow and change. No
I felt safe and able to ask questions.	I felt safe and able to ask questions. Yes	I felt safe and able to ask questions. No
My initial service was handled in a professional manner.	My initial service was handled in a professional manner. Yes	My initial service was handled in a professional manner. No
The service I received was helpful.	The service I received was helpful. Yes	The service I received was helpful. No
I was treated with respect by staff.	I was treated with respect by staff. Yes	I was treated with respect by staff. No
I had confidence in my primary staff members' knowledge and skills.	I had confidence in my primary staff members' knowledge and skills. Yes	I had confidence in my primary staff members' knowledge and skills. No
My expectations for getting help were met.	My expectations for getting help were met. Yes	My expectations for getting help were met. No
Staff were sensitive to my cultural/ethnic background.	Staff were sensitive to my cultural/ethnic background. Yes	Staff were sensitive to my cultural/ethnic background. No

Question Title

* 7. Services Received (Continued)

	Yes	No	N/A
Staff helped me so I could manage my life and change/recover.	Staff helped me so I could manage my life and change/recover. Yes	Staff helped me so I could manage my life and change/recover. No	Staff helped me so I could manage my life and change/recover. N/A
Staff made sure sessions, groups or home visits started on time.	Staff made sure sessions, groups or home visits started on time. Yes	Staff made sure sessions, groups or home visits started on time. No	Staff made sure sessions, groups or home visits started on time. N/A
My primary counselor/therapist/educator and I worked together to plan my treatment/program.	My primary counselor/therapist/educator and I worked together to plan my treatment/program. Yes	My primary counselor/therapist/educator and I worked together to plan my treatment/program. No	My primary counselor/therapist/educator and I worked together to plan my treatment/program. N/A
The staff explained the payment process to me.	The staff explained the payment process to me. Yes	The staff explained the payment process to me. No	The staff explained the payment process to me. N/A
The staff helped me with my payment plan.	The staff helped me with my payment plan. Yes	The staff helped me with my payment plan. No	The staff helped me with my payment plan. N/A

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* 8. I felt my confidentiality was kept.

Yes

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* 9. Services were available to me at times that were convenient.

Yes

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* 10. Please rate your overall experience with Rim Family Services.

Excellent

Good

Adequate

Poor

Very Poor

Excellent

Good

Adequate

Poor

Very Poor

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* 11. Rim Family Services provided me with referrals to other programs when they were unable to provide the services I needed.

Yes

N/A

If yes (please specify)

CLIENT SATISFACTION SURVEY

Question Title

* 1. My initial phone call was answered promptly and politely.

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* 2. I participated in the following program(s):

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* 3. The location of my program/service was convenient for me.

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* 4. On my first contact with RFS, I was greeted promptly and politely.

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* 5. Ethnic background (response is optional).

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* 6. Services Received

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* 7. Services Received (Continued)

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* 8. I felt my confidentiality was kept.

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* 9. Services were available to me at times that were convenient.

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* 10. Please rate your overall experience with Rim Family Services.

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* 11. Rim Family Services provided me with referrals to other programs when they were unable to provide the services I needed.

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* 12. Other services you wish Rim Family Services would offer their clients.

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* 13. Any other comments you wish to make.