4054 South Memorial Drive, Suite K
Winterville, NC 28590
Tel 252-561-8112 | Fax: 252-561-7455

Company
Quality Improvement
Resources
Survey - Legal Guardians and/or Family Members
Overall, how satisfied are you with Paradigm's Mental Health service provided to your family member or the person you represent?
List areas that can be improved and possible recommendations for their improvement:
Has there been a positive influence or change in the person supported since receiving services from Paradigm?
Please feel free to provide suggestions as to how we could make more of a positive impact or change within the individual:
Are you, as the guardian and/or family member, satisfied with the staff working with the person supported?
If No, please explain:  
Do you feel that your family member or person you represent has ever experienced any type of abuse or neglect while under Paradigm's care?
If Yes, explain:  
If the person supported resides in a residential facility with Paradigm, how satisfied are you with the security of the home and supervision by staff members
How satisfied are you with the treatment that your loved one or person you represent is receiving at the residential facility from staff members and others who live in the home?
Do you feel comfortable talking with staff members about any issues and/or concerns that you may feel displeased with regarding your loved one or the person you represent?

Do you feel that your loved one or the person you represent is receiving the appropriate amount of services to meet their needs?

How satisfied are you with the amount of freedom, privacy, and personal time/space that your loved one or the person you represent is allowed within the home?
How satisfied are you with the house rules and policies that are being used to add structure to the home environment?
Any suggestions/proposed changes?  
When you are visiting your loved one or person you represent, how satisfied are you with the space and privacy provided?

How satisfied are you with your loved one's ability to access their personal property and finances?

Do you feel that things are explained to you and/or your loved one or person you represent in a manner that you and/or they can understand?
If No, please explain:  
Do you feel that your family member or the person you represent is involved in enough activities?
If No, what would you suggest?  
Do you feel that your loved one or the person you represent is safe where he or she lives, works, or go to school?
Do you feel that your loved one or the person you represent is satisfied with where he/she lives?
I chose Paradigm for services because of (circle any that apply):





If Other, Please provide services:  
I have been with Paradigm for:
What do you like about Paradigm:









If Other, Please provide reason:  
In what way are you most satisfied with Paradigm?
What area do you feel needs the most improvement at Paradigm?
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