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Referral Survey (NJ Connect for Recovery)
GomoWPAdmin
2019-05-14T14:06:03+00:00
Please complete the following information fields to the best of your ability.
During your contact with NJ Connect for Recovery call line, were you given any referrals to behavioral health treatment services?
*
Yes
No
Were you able to get an appointment for the service(s) you were seeking?
*
Yes
No
How long did you wait to have your first appointment?
*
Within two weeks
More than one month
More than two months
Longer
How long did you wait for your first appointment?
*
If you have received services, have the services helped your situation?
*
Yes
No
Would you like further assistance from us?
*
Yes
No
Please provide the best number to reach you at:
*
How would you rate your overall satisfaction with NJ Connect for Recovery services on a scale of 1-5?*
*
5 - Excellent
4 - Good
3 - No Opinion
2 - Fair
1 - Poor
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