Patient Satisfaction Survey

2. What is your age?

• 17 or younger
• 18 to 24
• 25 to 34
• 35 to 44
• 45 to 54
• 55 to 64
• 65 to 74
• 75 or older

4. What is your gender?

• Male
• Female
• Non Gender Conforming

5. Admission State

Space Cell	Strongly Agree	Agree	Disagree	Strongly Disagree	N/A
The admission staff was responsive and answered my questions in a timely manner.	The admission staff was responsive and answered my questions in a timely manner.: Strongly Agree	The admission staff was responsive and answered my questions in a timely manner.: Agree	The admission staff was responsive and answered my questions in a timely manner.: Disagree	The admission staff was responsive and answered my questions in a timely manner.: Strongly Disagree	The admission staff was responsive and answered my questions in a timely manner.: N/A
The admission procedure was hassle-free and not time-consuming.	The admission procedure was hassle-free and not time-consuming.: Strongly Agree	The admission procedure was hassle-free and not time-consuming.: Agree	The admission procedure was hassle-free and not time-consuming.: Disagree	The admission procedure was hassle-free and not time-consuming.: Strongly Disagree	The admission procedure was hassle-free and not time-consuming.: N/A
Staff clearly explained the program’s rules and expectations.	Staff clearly explained the program’s rules and expectations.: Strongly Agree	Staff clearly explained the program’s rules and expectations.: Agree	Staff clearly explained the program’s rules and expectations.: Disagree	Staff clearly explained the program’s rules and expectations.: Strongly Disagree	Staff clearly explained the program’s rules and expectations.: N/A
Staff provided a program schedule, including group times, meal times, med pass times, and visiting hours.	Staff provided a program schedule, including group times, meal times, med pass times, and visiting hours.: Strongly Agree	Staff provided a program schedule, including group times, meal times, med pass times, and visiting hours.: Agree	Staff provided a program schedule, including group times, meal times, med pass times, and visiting hours.: Disagree	Staff provided a program schedule, including group times, meal times, med pass times, and visiting hours.: Strongly Disagree	Staff provided a program schedule, including group times, meal times, med pass times, and visiting hours.: N/A
Staff provided Patient Rights orientation.	Staff provided Patient Rights orientation.: Strongly Agree	Staff provided Patient Rights orientation.: Agree	Staff provided Patient Rights orientation.: Disagree	Staff provided Patient Rights orientation.: Strongly Disagree	Staff provided Patient Rights orientation.: N/A
Staff provided a tour of the facility including emergency exits.	Staff provided a tour of the facility including emergency exits.: Strongly Agree	Staff provided a tour of the facility including emergency exits.: Agree	Staff provided a tour of the facility including emergency exits.: Disagree	Staff provided a tour of the facility including emergency exits.: Strongly Disagree	Staff provided a tour of the facility including emergency exits.: N/A

6. Treatment Stage

Space Cell	Strongly Agree	Agree	Disagree	Strongly Disagree	N/A
My treatment staff was accessible outside of group to discuss my progress in treatment.	My treatment staff was accessible outside of group to discuss my progress in treatment.: Strongly Agree	My treatment staff was accessible outside of group to discuss my progress in treatment.: Agree	My treatment staff was accessible outside of group to discuss my progress in treatment.: Disagree	My treatment staff was accessible outside of group to discuss my progress in treatment.: Strongly Disagree	My treatment staff was accessible outside of group to discuss my progress in treatment.: N/A
My treatment team respected my wishes regarding involvement of family members and other concerned persons in my treatment.	My treatment team respected my wishes regarding involvement of family members and other concerned persons in my treatment.: Strongly Agree	My treatment team respected my wishes regarding involvement of family members and other concerned persons in my treatment.: Agree	My treatment team respected my wishes regarding involvement of family members and other concerned persons in my treatment.: Disagree	My treatment team respected my wishes regarding involvement of family members and other concerned persons in my treatment.: Strongly Disagree	My treatment team respected my wishes regarding involvement of family members and other concerned persons in my treatment.: N/A
My treatment team respected me as an individual, providing information which helped me to take charge of my own treatment.	My treatment team respected me as an individual, providing information which helped me to take charge of my own treatment.: Strongly Agree	My treatment team respected me as an individual, providing information which helped me to take charge of my own treatment.: Agree	My treatment team respected me as an individual, providing information which helped me to take charge of my own treatment.: Disagree	My treatment team respected me as an individual, providing information which helped me to take charge of my own treatment.: Strongly Disagree	My treatment team respected me as an individual, providing information which helped me to take charge of my own treatment.: N/A
I was involved in decisions about my treatment.	I was involved in decisions about my treatment.: Strongly Agree	I was involved in decisions about my treatment.: Agree	I was involved in decisions about my treatment.: Disagree	I was involved in decisions about my treatment.: Strongly Disagree	I was involved in decisions about my treatment.: N/A
The staff is supportive and believes that I can grow, change, and improve.	The staff is supportive and believes that I can grow, change, and improve.: Strongly Agree	The staff is supportive and believes that I can grow, change, and improve.: Agree	The staff is supportive and believes that I can grow, change, and improve.: Disagree	The staff is supportive and believes that I can grow, change, and improve.: Strongly Disagree	The staff is supportive and believes that I can grow, change, and improve.: N/A
I felt comfortable asking questions about my services, treatment, and/or medication.	I felt comfortable asking questions about my services, treatment, and/or medication.: Strongly Agree	I felt comfortable asking questions about my services, treatment, and/or medication.: Agree	I felt comfortable asking questions about my services, treatment, and/or medication.: Disagree	I felt comfortable asking questions about my services, treatment, and/or medication.: Strongly Disagree	I felt comfortable asking questions about my services, treatment, and/or medication.: N/A
The nursing staff was courteous, knowledgeable, and attentive to my medical needs.	The nursing staff was courteous, knowledgeable, and attentive to my medical needs.: Strongly Agree	The nursing staff was courteous, knowledgeable, and attentive to my medical needs.: Agree	The nursing staff was courteous, knowledgeable, and attentive to my medical needs.: Disagree	The nursing staff was courteous, knowledgeable, and attentive to my medical needs.: Strongly Disagree	The nursing staff was courteous, knowledgeable, and attentive to my medical needs.: N/A
The nursing staff addressed my health needs, including medications and emergency appointments, in a timely manner.	The nursing staff addressed my health needs, including medications and emergency appointments, in a timely manner.: Strongly Agree	The nursing staff addressed my health needs, including medications and emergency appointments, in a timely manner.: Agree	The nursing staff addressed my health needs, including medications and emergency appointments, in a timely manner.: Disagree	The nursing staff addressed my health needs, including medications and emergency appointments, in a timely manner.: Strongly Disagree	The nursing staff addressed my health needs, including medications and emergency appointments, in a timely manner.: N/A
Staff was respectful and supportive, helping me to understand and follow program rules.	Staff was respectful and supportive, helping me to understand and follow program rules.: Strongly Agree	Staff was respectful and supportive, helping me to understand and follow program rules.: Agree	Staff was respectful and supportive, helping me to understand and follow program rules.: Disagree	Staff was respectful and supportive, helping me to understand and follow program rules.: Strongly Disagree	Staff was respectful and supportive, helping me to understand and follow program rules.: N/A
Facility food service provided was of sufficient quality, variety, and portion size, and attentive to any special dietary needs.	Facility food service provided was of sufficient quality, variety, and portion size, and attentive to any special dietary needs.: Strongly Agree	Facility food service provided was of sufficient quality, variety, and portion size, and attentive to any special dietary needs.: Agree	Facility food service provided was of sufficient quality, variety, and portion size, and attentive to any special dietary needs.: Disagree	Facility food service provided was of sufficient quality, variety, and portion size, and attentive to any special dietary needs.: Strongly Disagree	Facility food service provided was of sufficient quality, variety, and portion size, and attentive to any special dietary needs.: N/A
The facility was clean and comfortable.	The facility was clean and comfortable.: Strongly Agree	The facility was clean and comfortable.: Agree	The facility was clean and comfortable.: Disagree	The facility was clean and comfortable.: Strongly Disagree	The facility was clean and comfortable.: N/A
I felt safe and secure during my time at this facility.	I felt safe and secure during my time at this facility.: Strongly Agree	I felt safe and secure during my time at this facility.: Agree	I felt safe and secure during my time at this facility.: Disagree	I felt safe and secure during my time at this facility.: Strongly Disagree	I felt safe and secure during my time at this facility.: N/A
Since I have started the program my substance use has decreased.	Since I have started the program my substance use has decreased.: Strongly Agree	Since I have started the program my substance use has decreased.: Agree	Since I have started the program my substance use has decreased.: Disagree	Since I have started the program my substance use has decreased.: Strongly Disagree	Since I have started the program my substance use has decreased.: N/A
Since starting the program I have become more optimistic about my future.	Since starting the program I have become more optimistic about my future.: Strongly Agree	Since starting the program I have become more optimistic about my future.: Agree	Since starting the program I have become more optimistic about my future.: Disagree	Since starting the program I have become more optimistic about my future.: Strongly Disagree	Since starting the program I have become more optimistic about my future.: N/A
Since starting the program, my use of illicit opioids has decreased .	Since starting the program, my use of illicit opioids has decreased .: Strongly Agree	Since starting the program, my use of illicit opioids has decreased .: Agree	Since starting the program, my use of illicit opioids has decreased .: Disagree	Since starting the program, my use of illicit opioids has decreased .: Strongly Disagree	Since starting the program, my use of illicit opioids has decreased .: N/A

7. Overall Satisfaction

Space Cell	Strongly Agree	Agree	Disagree	Strongly Disagree	N/A
I have a better understanding of my illness and am better equipped to manage my treatment.	I have a better understanding of my illness and am better equipped to manage my treatment.: Strongly Agree	I have a better understanding of my illness and am better equipped to manage my treatment.: Agree	I have a better understanding of my illness and am better equipped to manage my treatment.: Disagree	I have a better understanding of my illness and am better equipped to manage my treatment.: Strongly Disagree	I have a better understanding of my illness and am better equipped to manage my treatment.: N/A
Overall, I was satisfied with the services I received.	Overall, I was satisfied with the services I received.: Strongly Agree	Overall, I was satisfied with the services I received.: Agree	Overall, I was satisfied with the services I received.: Disagree	Overall, I was satisfied with the services I received.: Strongly Disagree	Overall, I was satisfied with the services I received.: N/A
If I were to ever need treatment again, I would want to come back to this program.	If I were to ever need treatment again, I would want to come back to this program.: Strongly Agree	If I were to ever need treatment again, I would want to come back to this program.: Agree	If I were to ever need treatment again, I would want to come back to this program.: Disagree	If I were to ever need treatment again, I would want to come back to this program.: Strongly Disagree	If I were to ever need treatment again, I would want to come back to this program.: N/A
If a friend or family member was in need of similar help, I would recommend this program.	If a friend or family member was in need of similar help, I would recommend this program.: Strongly Agree	If a friend or family member was in need of similar help, I would recommend this program.: Agree	If a friend or family member was in need of similar help, I would recommend this program.: Disagree	If a friend or family member was in need of similar help, I would recommend this program.: Strongly Disagree	If a friend or family member was in need of similar help, I would recommend this program.: N/A

8. Discharge

Space Cell	Yes	No	Still in treatment
At the time of discharge, I was provided with a continuing care plan.	At the time of discharge, I was provided with a continuing care plan.: Yes	At the time of discharge, I was provided with a continuing care plan.: No	At the time of discharge, I was provided with a continuing care plan.: Still in treatment
At the time of discharge, I was referred to appropriate after care.	At the time of discharge, I was referred to appropriate after care.: Yes	At the time of discharge, I was referred to appropriate after care.: No	At the time of discharge, I was referred to appropriate after care.: Still in treatment