Zepf Center wants to provide you with the best service possible. Please take a few minutes to let us know how we are doing.
This survey focuses on your personal opinion of Zepf Center and the services we provided to you. It asks you about your opinions related to the service you have received, as well as your overall satisfaction with Zepf Center.
Thank you for taking time to tell us how we are doing.

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* 1. Date survey completed:

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* 2. Please tell us your relationship to the person receiving services:

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* 3. Please indicate your (the patient’s) gender identity

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* 4. Select the category which includes your age (the patient’s)

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* 5. Please indicate your (the patient's) racial or ethnicity that best describes you

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* 6. Where is your (the patient's) primary residence located?

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* 7. Which location(s) do you receive services (check all that apply):

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* 8. What services do you receive at Zepf Center (check all that apply):

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* 9. I am treated with dignity and respect by Zepf Center staff

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* 10. Zepf Center staff listens carefully and understood my concerns or needs

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* 11. The service I have received so far has helped my problem or situation

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* 12. I would recommend Zepf Center to a friend or family member

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* 13. The building is clean and inviting.

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* 14. Zepf is respectful of my cultural background (race, religion, language, etc.)

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* 15. My treatment team spoke to me in a way that is easy to understand.

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* 16. I am confident in my treatment team’s ability to help me.

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* 17. I was able to obtain enough information about my diagnosis.

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* 18. Staff responded to my phone messages within two business days.

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* 19. I am an active participant in my treatment and care plan.

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* 20. Zepf locations and hours of operations are convenient for me.

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* 21. The wait time to enter treatment was acceptable.

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* 22. The quality of my relationships have improved since starting at Zepf Center.

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* 23. My mental health has improved since starting services at Zepf Center.

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* 24. Has any Zepf Center staff introduced the Sanctuary Tools and/or concepts to you in groups or individual interventions such as Community Meeting, Seven Core Principles, Safety Plan, Self-Care Plan or SELF?

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* 25. Have you delayed or avoided receiving care from us because you could not afford the cost of our services?

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* 26. Overall, what benefit have you had from the treatment at Zepf?

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* 27. What did not help you at Zepf Center?

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* 28. How can we improve?

Thank you! Your feedback is appreciated   
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