I have been provided a service that increased my hope. *5 Strongly Agree4 Mostly Agree 3 Agree2 Mostly Disagree 1 Strongly Disagree
Please use the following scale to rate the degree to which you agree or disagree with the following statements: 5 = Strongly Agree 4 = Mostly Agree 3=Agree 2 = Mostly Disagree 1 = Strongly DisagreeI was treated with dignity and respect throughout service delivery. *5 Strongly Agree4 Mostly Agree3 Agree2 Mostly Disagree 1 Strongly Disagree
Please use the following scale to rate the degree to which you agree or disagree with the following statements: 5 = Strongly Agree 4 = Mostly Agree 3 = Agree 2 = Mostly Disagree 1 = Strongly DisagreeMy grievances and concerns were addressed. *I had no Grievances and Concerns5 Strongly Agree4 Mostly Agree3 Agree2 Mostly Disagree 1 Strongly Disagree
Please use the following scale to rate the degree to which you agree or disagree with the following statements: 5 = Strongly Agree 4 = Mostly Agree 3 = Agree 2 = Mostly Disagree 1 = Strongly DisagreeCounseling services focused on improving my quality of emotional & psychological functioning. *5 Strongly Agree4 Mostly Agree3 Agree2 Mostly Disagree 1 Strongly Disagree
Please use the following scale to rate the degree to which you agree or disagree with the following statements: 5 = Strongly Agree 4 = Mostly Agree 3 = Agree 2 = Mostly Disagree 1 = Strongly DisagreeMy overall impression of Chrysalis is: * 5 = Very Good4 = Above Average3 = Average2 = Below Average 1 = Poor
Please use the following scale to answer the following statements: 5 = Very Good 4 = Above Average 3 = Average 2 = Below Average 1 = PoorI was provided choices related to counseling, possible referrals, possible support groups: * 5 = Very Good4 = Above Average3 = Average 2 = Below Average 1 = Poor
Please use the following scale to answer the following statements: 5 = Very Good 4 = Above Average 3 = Average 2 = Below Average 1 = PoorI gained access to service easily and in a timely fashion. * 5 = Very Good4 = Above Average3 = Average2 = Below Average1 = Poor
Please use the following scale to answer the following statements: 5 = Very Good 4 = Above Average 3 = Average 2 = Below Average 1 = PoorCounseling service provided was beneficial and added to my life in a positive way: * 5 = Very Good 4 = Above Average 3 = Average 2 = Below Average1 = Poor
Please use the following scale to answer the following statements: 5 = Very Good 4 = Above Average 3 = Average 2 = Below Average 1 = PoorI was involved in ongoing counseling treatment plan development: * 5 = Very Good4 = Above Average3 = Average2 = Below Average1 = Poor
Please use the following scale to answer the following statements: 5 = Very Good 4 = Above Average 3 = Average 2 = Below Average 1 = PoorPLEASE SHARE ANY COMMENTS, POSITIVE OR NEGATIVE:
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