1. Were you treated with courtesy and respect during your initial appointment phone call? *
2. Were you given good directions on how to get to the office? *
3. Did you receive a phone call to remind you of your intake appointment? *
4. Were you seen for your intake appointment in a timely manner? *
5. Was the waiting room comfortable and clean? *
6. Was the therapist respectful and courteous? *
7. Did the therapist listen to everything you had to say? *
8. Was your program explained to you at the time of your first appointment? *
8a. If yes, did you understand what you were told? *
9. During Orientation, were the program rules, fee structure, your rights and responsibilities clearly explained to you? *
10. During Orientation, were all your questions about the program answered? *
11. Do you think you will benefit from outpatient treatment? *
12. Rate your Orientation facilitator today? *