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Client Satisfaction Survey

Please try your best to fill out the form below. If you have any questions, please ask your client intake coordinator.

"*" indicates required fields

Client Future Address*
Admission Date (mm/dd/yyyy)*
Discharge Date (mm/dd/yyyy)*
Are you interested in Rockland's Alumni Program?*

INTAKE - When you first called Rockland Treatment Center:

ExcellentVery GoodGoodNeeds ImprovementPoor
ExcellentVery GoodGoodNeeds ImprovementPoor
ExcellentVery GoodGoodNeeds ImprovementPoor
ExcellentVery GoodGoodNeeds ImprovementPoor

THE PROGRAM:

ExcellentVery GoodGoodNeeds ImprovementPoor
ExcellentVery GoodGoodNeeds ImprovementPoor
ExcellentVery GoodGoodNeeds ImprovementPoor
ExcellentVery GoodGoodNeeds ImprovementPoor
ExcellentVery GoodGoodNeeds ImprovementPoor
ExcellentVery GoodGoodNeeds ImprovementPoor
Would you recommend Rockland Treatment Center?*
Would you come back if you had to?*

THE COUNSELORS:

ExcellentVery GoodGoodNeeds ImprovementPoor
Do you feel there are enough counselors?*
Were you made aware of and did you have input into the creation of your treatment plan?*
Is your counselor giving you as much time as you need?*

HOUSING & TRANSPORTATION:

ExcellentVery GoodGoodNeeds ImprovementPoor
Did techs get you to groups and appointments on time?*
ExcellentVery GoodGoodNeeds ImprovementPoor
ExcellentVery GoodGoodNeeds ImprovementPoor

OTHER:

ExcellentVery GoodGoodNeeds ImprovementPoor
ExcellentVery GoodGoodNeeds ImprovementPoor
Are people using drugs or alcohol at Rockland Treatment Center?*
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