FEEDBACK SURVEY

Feedback Survey

Feedback Survey


Our Staff

Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A


 
Treatment Received

Not Well
Adequately
Very Well
Extremely Well
Not at all
Minimally
Very Much
Couldn't do without it
Not on Buprenorphine
Yes
No
Yes
No
Yes
No


 
Our Facility

1
2
3
4
5
N/A
1
2
3
4
5
N/A
1
2
3
4
5
N/A


 
Contact Information (Optional)

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