Assessment Services Survey Instructions Please take a moment to complete this survey about your experience during the assessment process. You answers will help us improve the quality of our services. When you start the Survey, please do NOT use the BACK button on your browser, instead, you may use the PREVIOUS and NEXT buttons below the questions to review your answers and make changes. Your survey submission will be held in the strictest confidence. We'd appreciate honest answers that are as complete as possible. Thank you, Assessment Services Full Name*Date of Birth* MM slash DD slash YYYY 1) Drug / Alcohol Evaluation1a. What agency provided your alcohol / drug evaluation?*1b. Do you feel the evaluator treated you with respect, concern and courtesy?* Yes No 1c. Do you believe your evaluation accurately reflected your level of alcohol and or drug consumption and any problems you have experienced related to drug or alcohol use?* Yes No 1d. Were you honest in your answers to the questions on the written test you were given?* Yes No 1e. If you answered no to items c, d or e please explain.2) Alcohol & Drug Information School (ADIS) Level I or Level II2a. With what agency did you attend your ADIS class?*2b. Do you feel the evaluator treated you with respect, concern and courtesy?* Yes No 2c. Did you think it was:* Beneficial Somewhat Beneficial Not Beneficial 2d. Were the facilities:* Excellent Good Fair Poor 2e. Comments3) Checkmate, Streetsmart, Anger Control, Batterers Intervention3a. If you attended one of the above education classes, did you think the classes were:* Beneficial Somewhat Beneficial Not Beneficial (Did not attend) 3b. Where did you attend this program?*3c. Comments4) Inpatient or Outpatient Alcohol or Drug Counseling4a. Did you attend inpatient or outpatient alcohol or drug counseling?* Yes No 4b. If yes, which treatment program did you attend?*4c. How often did you attend?*4d. Comments regarding your treatment program:5) Treatment by Court Representatives5a. Were you treated with fairness and respect by the Prosecutor?* Yes No 5b. Were you treated with fairness and respect by the Court Clerks?* Yes No 5c. Were you treated with fairness and respect by the Judge?* Yes No 5d. Were you treated with fairness and respect by your Attorney?* Yes No 5e. Comments:6) Treatment by Diversion / Probation Supervisor6a. Were you treated with courtesy, respect and concern by your Diversion / Probation Supervisor?* Yes No 6b. Comments:7) Manner of Diversion / Probation Supervisor7a. Did your Diversion / Probation Supervisor act in a professional and ethical manner?* Yes No 7b. Comments:8) Program Impact8a. What part of Diversion / Probation has had the most impact on you or did you find the most beneficial?9) Additional Comments or Information9a. Please include any additional compliments, criticisms, or general comments you might have.Thank You For Time We appreciate your time today...your honest answers are taken seriously and are used to help make our programs better. If needed, you may still use the PREVIOUS and NEXT buttons below to review your answers and make changes. Press the SUBMIT button when you are ready to finish the survey and submit your responses. On behalf of everyone at Assessment Services, we wish you well on your journey.PhoneThis field is for validation purposes and should be left unchanged.
