Allied Trades Assistance Program

How old are you?

What is your gender?
MaleFemalePrefer Not to Answer
Who referred you to the Allied Trades Assistance Program?
Self-referralFamily memberFriendCo-workerSupervisor (suggested contact)Supervisor (required contact)Other (please specify):

Have you or anyone in your family utilized this program in the past?
YesNo
If yes, how many times have you or your family member been in treatment in the past?

ATAP STAFF:

An ATAP staff person responded to my outreach call in a timely manner.
NA12345
The counselor I spoke to was friendly and helpful.
NA12345
The counselor I spoke to was knowledgeable.
NA12345
The counselor I spoke to seemed to care about my present/future concerns(s).
NA12345
The counselor I spoke to made the treatment process easier for me.
NA12345
I found it helpful when an ATAP staff person visited me while in treatment.
NA12345

REFERRAL:

What was the name of the provider where you or your family member received services? (Please list the most recent if more than one):

The referral that was given to me met my treatment needs and preferences.
NA12345
This provider’s services were satisfactory.
NA12345
My treatment included my family.
NA12345
I would recommend this provider to other people with similar treatment needs.
NA12345

PROGRAM SPECIFICS

I found the phone system easy to use.
NA12345
The office location was convenient for me to visit.
NA12345
The office environment was welcoming and comfortable.
NA12345
I would recommend this program to other people seeking help.
NA12345
Please indicate which areas an ATAP staff person provided you or your family member assistance with: (Please check all that apply)
Alcohol or substance abuseAnxietyChildren and/or adolescent issuesDecision makingDepressionDeveloping an action planDrug test failureEating disorderFamily concernFinancial issuesGrief and/or bereavementRelationship concernResolving a crisisSuicidal concernTraumaWorkplace concernOther (please specify):
Please add any additional comments or suggestions here:

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