Roxbury Treatment Center

Our Services

Referral Feedback Form

Your input is very important to us. Please take a moment to fill out this survey and submit online.

Please rate your experience on the Referral process into any of Roxbury's programs:

(1 - Strongly Disagree 2 - Disagree 3 - Neither Agree nor Disagree 4 - Agree and 5 - Strongly Agree N/A - Not Applicable)

1) Have you made a referral to any of Roxbury's programs within the past 6 months?
Yes No

If no please stop here and submit form online

2) If you have not made a referral to Roxbury's program in the past 6 months please indicate reason(s):

If Other please explain below

Other:

3) Referrals into any of Roxbury's programs are always quick and easy.
1 2 3 4 5 N/A

4) Roxbury's intake and nursing personnel are knowledgeable of all of Roxbury's services.
1 2 3 4 5 N/A

5) Roxbury is my first choice to refer an individual for their behavioral healthcare needs
1 2 3 4 5 N/A

6) I am certain of referral disposition after just one call to Roxbury
1 2 3 4 5 N/A

If you are a provider please rate your own or your clients experiences with treatment

(1 - Strongly Disagree 2 - Disagree 3 - Neither Agree nor Disagree 4 - Agree 5 - Strongly Agree N/A - Not Applicable)

7) Based on your client's experience at Roxbury, the nursing staff was knowledgeable and caring towards your client
1 2 3 4 5 N/A

8) The improvement in your client from admission to discharge is noticeable.
1 2 3 4 5 N/A

9) You are informed about your client's progress while they are in treatment with Roxbury.
1 2 3 4 5 N/A

10) You are receiving discharge summaries and other pertinent information in a timely manner when requested.
1 2 3 4 5 N/A

11) When working with clients who have been through a Roxbury program, they report positive experiences.
1 2 3 4 5 N/A

If you have been visited by a member of the Community Relations staff please rate your interactions.

(1 - Strongly Disagree 2 - Disagree 3 - Neither Agree nor Disagree 4 - Agree 5 - Strongly Agree N/A - Not Applicable)

12) You or your agency is visited by a marketing representative on a regular basis and are presented with up-to-date information on programming and other Roxbury news.
1 2 3 4 5 N/A

13) When I am visited by a member of the Community Relations team, I obtain up-to-date information in a pleasant and professional manner.
1 2 3 4 5 N/A

14) I feel the frequency of visits by Roxbury staff is appropriate to keep me (and my agency) informed and connected.
1 2 3 4 5 N/A

Additional Comments:

Would you like to be contacted regarding your feedback?
Yes No

If you choose, please list your contact information below

Name:

Agency:

Phone:

Email: