* Required Information
Full Name:
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Address:
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City:
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State:
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Zip:
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Yes
No
Comments
1.
I was satisfied with the agency's efforts to support my quality of life.
2.
The care was delivered timely.
3.
I felt the staff was available on weekends and after hours when we needed them.
4.
I understood my treatment plan and services provided.
5.
I know how to file a complaint with the state and/or the agency.
6.
I was notified timely if there was a change in my condition and/or a change in discipline seeing me.
Additional Comments
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