Your response to this evaluation form is extremely important to us. We are interested in your honest opinions, whether they are positive or negative. Your comments and suggestions assist us in monitoring and in improving our services. We thank you in advance for your help. The information provided is confidential.


For each statement below, please indicate how much you agree or disagree. Please circle the number representing your feelings about that statement.

(1) Strongly Disagree(2) Disagree(3) Neutral(4) Agree(5) Strongly Agree
Symptoms (presenting problems)
Attitude
Self-Control
Coping Skills
Relationships
Insight
(1) Strongly Disagree(2) Disagree(3) Neutral(4) Agree(5) Strongly Agree
Respectfully
Compassionately
Professionally
Collaboratively
Competently
With Understanding