Agency Satisfaction Survey

Please circle your choice from the answers below each question:

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* 1. I am able to contact/reach a staff member when needed.

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* 2. I feel I have made progress/improved my life by following my treatment plan.

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* 3. I feel that staff members perform their jobs professionally.

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* 4. The complaints/grievances process has been explained to me, and I know how to contact the Client Rights Advocate.

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* 5. CSS staff believe in recovery and encourage me to learn, grow and change - helping me to move toward recovery.

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* 6. I am able to get to and from the agency easily.

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* 7. How old are you?

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* 8. Are you of Spanish, Hispanic or Latino origin or descent?

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* 9. Please indicate your gender:

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* 10. Race: Please mark one or all that you consider yourself to be:

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* 11. What is your sexual orientation?

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* 12. Suggestions for Improvement?

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