Survey - Clients - Life Balance Recovery

Your Name *

Your Phone Number

Your Email *

Discharge Date

Involvement in treatment planning *

1

2

3

4

5

Identifying and addressing relevant issues *

1

2

3

4

5

Experience with individual counselor *

1

2

3

4

5

Experience with peer group & facilitator *

1

2

3

4

5

Education on relevant issues *

1

2

3

4

5

Therapeutic environment *

1

2

3

4

5

Experiential activities *

1

2

3

4

5

Overall experience with staff *

1

2

3

4

5

How would you rate your overall experience at our facility? *

1

2

3

4

5

What lead you to Life Balance Recovery?

A medical or mental health provider referred me

I wanted to make a change in my life

A family member or friend encouraged me

I was required by court or legal system

My employer or EAP referred me

Other

What services have been most beneficial to your recovery journey?

Individual Therapy

Group Therapy

Intensive Outpatient Program (IOP)

Life Skills or Educational Classes

Case Management

Family Therapy or Support

I’m not sure

How could we better support your recovery process?

Offer more flexible scheduling

Provide additional one-on-one support

Increase access to resources (housing, job help, etc.)

Improve communication from staff

Client Survey

Privacy Settings

Functional