MHC KPI Assessment Form (Others Use)
Client's First Name:
Client's Last Name:
3. How has your physical health been?:
--None--
Very poor
Fair
Satisfactory
Good
Very Good
4. How has your mental health been? (e.g. your emotional wellbeing/stress level)
--None--
Very poor
Fair
Satisfactory
Good
Very Good
5. How have your relationships with other people been?
--None--
Very poor
Fair
Satisfactory
Good
Very Good
7. Has your confidence in being able to respond to AOD issues increased?
--None--
Not at all
A little
Moderately
A lot
Extremely
8. How satisfied are you with the service provided?
--None--
Not at all
A little
Moderately
A lot
Extremely
Submit
