Referral Source Survey

*All fields are required to submit the survey.

Organization:*
Position within Organization:*
Approximate or actual number of referrals or common consumers with Catalyst Life Services within the last year: (Please check appropriate response)*




1. How easy is it to refer consumers to our agency for treatment?*
  Poor Fair Average Above Average Excellent
2. How well do we provide general information about our agency to you? *
  Poor Fair Average Above Average Excellent
3. How well do we give feedback to you on consumers referred? *
  Poor Fair Average Above Average Excellent
The next questions are open ended for more detailed feedback:
1. Is our referral process understandable?*
2. What could we improve about ourselves as an agency?*
3. What further information could we provide you to enhance your knowledge of our agency?*
4. What do we do well as an agency?*
5. Please provide us with suggestions for improving access in all the areas discussed.*
6. Please identify any staff persons who particularly stand out as exemplary employees.*
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New Beginnings Drug and Alcohol Treatment

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