Client Satisfaction Survey Template - PDF by kqn65350

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									     California Access to Recovery Effort
     (CARE)                                                                         Form 16


                      CLIENT SATISFACTION SURVEY



                    Administration Guide for Assessment Providers


The client satisfaction survey is a very important part of evaluating the CARE program. The
survey measures overall client satisfaction with CARE services and helps the Department of
Alcohol and Drug Programs (ADP) and its partners to continually improve the CARE
program. Client satisfaction surveys are distributed by assessment providers and mailed
directly to ADP by the client with a business return envelope.

Administration Procedures:

• Assessment providers should maintain a supply of client satisfaction surveys and business
  reply envelopes. The CARE Client Satisfaction Survey is available as a pdf file and can
  be opened and printed with Adobe Acrobat reader. If you prefer, ADP can print a batch of
  surveys and provide them to you. Business return envelopes are provided by ADP. If you
  need more business reply envelopes or client satisfaction surveys please contact Michelle
  Martinez at 916-327-5650.


• Provide one survey form and one business reply envelope to each client during
  their discharge Government Performance and Results Act (GPRA) interview, or at
  the 6-month post intake GPRA interview if they did not complete one upon
  discharge. Ask them to rate the CARE services they received.


• Emphasize the importance of completing the satisfaction survey and encourage the client
  to return it to ADP. Inform the client that postage is not needed to mail the completed
  survey.


If you have questions or need assistance please contact Michelle Martinez at 916-327-5650.
        California Access to Recovery Effort
       (CARE)                                                                                                 Form 16


                              CLIENT SATISFACTION SURVEY

Please help us to improve the CARE program by answering some questions about the services you have
received. Your answers are confidential and will not affect current or future services. Do not write your name on
the survey form. Answer the questions based on all the services you received in the CARE program. Rate only
the services you received in the CARE program. Indicate if you Strongly Disagree, Disagree, are Not Sure, Agree,
or Strongly Agree. For each survey item below, fill in the circle that best describes your opinion about your CARE
services. When you are finished, seal the survey in the envelope provided and drop it in the mail. A stamp is not
required for mailing; postage is paid. Thank you for your assistance.



                                                                 Strongly      Disagree     Not       Agree    Strongly
                                                                 Disagree                   Sure                Agree

1. Overall, I am satisfied with the services I received.              O           O          O          O         O
2. I helped to choose my services.                                  O             O          O          O         O
3. I received the services that were right for me.                    O           O          O          O         O
4. The location of the services was convenient.                       O           O          O          O         O
5. Services were available at times that were convenient              O           O          O          O         O
    for me.
6. I got the help I wanted.                                           O           O          O          O         O
7. Staff respected my religious/spiritual beliefs.                  O             O          O          O         O
8. Staff was sensitive to my cultural/ethnic background.            O             O          O          O         O
9. I would recommend the CARE program to a friend if he               O           O          O          O         O
    or she needed similar help.
10. I received recovery support services (educational services, employment services, mentoring, spiritual coaching,
   childcare, or transportation). O No     O Yes If yes, what type?

11. Please provide written comments here. We are interested in both positive and negative feedback. Use the
    back of the page if you need more space.




Please answer the following questions to let us know a little about you.


What is your gender?                   O Male        O Female   O Other
Are you Hispanic or Latino?            O Yes         O No

What is your race?                     O American Indian/Alaska Native        O Asian     O Black or African American
(Choose all that apply).               O Hawaiian or other Pacific Islander       O White          O Other:

								
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