Please enable JavaScript in your browser to complete this form.I have been provided a service that increased my hope. *5 Strongly Agree4 Mostly Agree 3 Agree2 Mostly Disagree 1 Strongly DisagreePlease 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 Disagree I was treated with dignity and respect throughout service delivery. *5 Strongly Agree4 Mostly Agree3 Agree2 Mostly Disagree 1 Strongly DisagreePlease 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 Disagree My grievances and concerns were addressed. *I had no Grievances and Concerns5 Strongly Agree4 Mostly Agree3 Agree2 Mostly Disagree 1 Strongly DisagreePlease 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 Disagree Counseling services focused on improving my quality of emotional & psychological functioning. *5 Strongly Agree4 Mostly Agree3 Agree2 Mostly Disagree 1 Strongly DisagreePlease 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 Disagree My overall impression of Chrysalis is: * 5 = Very Good4 = Above Average3 = Average2 = Below Average 1 = PoorPlease use the following scale to answer the following statements: 5 = Very Good 4 = Above Average 3 = Average 2 = Below Average 1 = Poor I was provided choices related to counseling, possible referrals, possible support groups: * 5 = Very Good4 = Above Average3 = Average 2 = Below Average 1 = PoorPlease use the following scale to answer the following statements: 5 = Very Good 4 = Above Average 3 = Average 2 = Below Average 1 = Poor I gained access to service easily and in a timely fashion. * 5 = Very Good4 = Above Average3 = Average2 = Below Average1 = PoorPlease use the following scale to answer the following statements: 5 = Very Good 4 = Above Average 3 = Average 2 = Below Average 1 = Poor Counseling service provided was beneficial and added to my life in a positive way: * 5 = Very Good 4 = Above Average 3 = Average 2 = Below Average1 = PoorPlease use the following scale to answer the following statements: 5 = Very Good 4 = Above Average 3 = Average 2 = Below Average 1 = Poor I was involved in ongoing counseling treatment plan development: * 5 = Very Good4 = Above Average3 = Average2 = Below Average1 = PoorPlease use the following scale to answer the following statements: 5 = Very Good 4 = Above Average 3 = Average 2 = Below Average 1 = Poor PLEASE SHARE ANY COMMENTS, POSITIVE OR NEGATIVE:Enter your comments here (optional)Submit