This survey is completed by clients as they come into the office for services or by therapist providing services in the field on scheduled “survey days” during the month. To be completed by clients aged 7 years and older. Staff may read questions to young clients and assist them in filling out the survey. Please check the one response that best describes how you feel about each statement.
Division -- Northern Kentucky South Bend Cincinnati DRC Columbia Las Vegas Columbus/Groveport Montgomery Shelter Services Oklahoma City Huntsville Cleveland Louisville Lawton SAFY Behavioral Health Charleston Lexington Somerset Arlington Findlay/Lima Muncie Dayton Birmingham Tiffin Sidney Greenville Canton/Akron Ft. Wayne Merrillville AMERICA RANCHO DRIVE PATRICK LANE DCR DESERT COTTAGE
Service Program -- In Home Services Outpatient Services Alcohol and Drug Not Identified
SAFY Worker / Therapist
I am 18 or older -- Yes No
Date:
I am satisfied with the services I receive. -- Rarely Seldom Sometimes Most of the Time
I am treated with dignity and respect by SAFY Staff (My SAFY worker listens to me). -- Rarely Seldom Sometimes Most of the Time
I feel I am getting better. -- Rarely Seldom Sometimes Most of the Time
I believe that my SAFY worker/ therapist understands and helps me. -- Rarely Seldom Sometimes Most of the Time
My SAFY worker/ therapist responds to my questions and concerns in a timely manner. -- Rarely Seldom Sometimes Most of the Time
Appointments are scheduled at a time convenient for me. -- Rarely Seldom Sometimes Most of the Time
I am involved in my treatment planning. -- Rarely Seldom Sometimes Most of the Time
My SAFY worker respects/understands my values and beliefs. -- Rarely Seldom Sometimes Most of the Time
I would recommend SAFY to other people I know. -- Rarely Seldom Sometimes Most of the Time
Additional Comments