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1.
Please enter your date of birth.
As a reminder, your responses are confidential and we will not know how you responded. This information is only used to ensure we do not receive duplicate responses.
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2.
Please enter your first and last initials.
As a reminder, your responses are confidential and we will not know how you responded. This information is only used to ensure we do not receive duplicate responses.
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3.
Please indicate how much you agree or disagree with each of the following statements about the mental health and/or substance use services you received in the last 6 months by marking the number that best represents your opinion. If the state is about something you have not experienced, answer "N/A" to indicate it is not applicable to you.
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I like the services that I received.
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If I had other choices, I would still get services from the same agency.
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I would recommend the same agency to a friend or family member.
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The location of services was convenient (parking, public transportation, distance, etc.)
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Staff were willing to see me as often as I felt it was necessary.
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Staff returned my calls within 24 hours.
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Services were available at times that were good for me.
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I was able to get all the services I thought I needed.
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I was able to see a psychiatrist when I wanted to.
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Staff believed that I could grow, change, and recover.
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I felt comfortable asking questions about my treatment and medication.
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I felt free to complain.
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I was given information about my rights.
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Staff encouraged me to take responsibility for how I live my life.
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Staff told me what side effects to watch out for.
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Staff respected my wishes about who is and who is not to be given information about my treatment.
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I, not staff, decided my treatment goals.
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Staff was sensitive to my cultural background (race, religion, language, etc.).
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Staff helped me obtain the information I needed so that I could take charge of managing my mental health and/or substance use condition.
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I was encouraged to use consumer-run programs (support groups, drop in centers, warm line, etc.).
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4.
As a direct result of the mental health and/or substance use services I received in the last 6 months...
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5.
Please answer about current relationships you have with persons other than your mental health and/or substance use providers.
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