CARS Referral Source Survey

Question Title

1. CARS program I contacted?

Residential

Outpatient

Outpatient Rehabilitation

Question Title

2. I represent:

Drug Court

Probation

Parole

Treatment Program

Department of Social Services

Medical Provider/Hospital

Other (please Specify)

Other (please specify)

Question Title

3. My overall experience with CARS' referral process:

Exceeds Expectations

Meets Expectations

Needs Improvement (please specify suggested improvements)

Please Suggest Areas of Improvement

Question Title

4. My overall experience with CARS' treatment programs:

Exceeds Expectations

Meets Expectations

Needs Improvement (please specify suggested improvements)

Please Suggest Areas of Improvement

Question Title

5. If you would like us to contact you to discuss your responses, please provide your contact information below:

E-Mail Address:

Telephone Number:

Mailing Address: