CLIENT SURVEY

1. I took part in choosing which services I would receive:

I took part in choosing which services I would receive: Strongly Agree

Agree

Disagree

2. The services I receive help me with my problems:

The services I receive help me with my problems: Yes, very helpful	Helpful	No
Comments:

3. I am happy with the services I receive

I am happy with the services I receive Strongly agree	Agree	Disagree
Comments:

4. The location where I received Mental Health services was good.

The location where I received Mental Health services was good. Strongly agree

Agree

Disagree

5. I was happy with the waiting time between when I was first contacted by the Center and when I actually was seen:

I was happy with the waiting time between when I was first contacted by the Center and when I actually was seen: Strongly Agree

Agree

Disagree

6. Have you used our Crisis Services?

Have you used our Crisis Services? Yes	No
Comments:

7. I used crisis services:

I used crisis services: During work hours

Afterwork hours

8. The crisis services provided were helpful to me:

The crisis services provided were helpful to me: Yes	No
If no, please tell us what would have been helpful

9. The clinical staff answered my questions about psychotropic medication: (e.g. anti-depressants)

The clinical staff answered my questions about psychotropic medication: (e.g. anti-depressants) All the time

Usually

Does not apply

10. Counseling Services has helped me get or referred me to obtain Food, Medical Treatment, Housing or Legal services.

Counseling Services has helped me get or referred me to obtain Food, Medical Treatment, Housing or Legal services. Agree

Somewhat Agree

Disagee

Does Not Apply

11. I feel the Mental Health Staff understands my needs about:

	Ethnic/Culture	Age	Disability	Sexual Minority Status
Yes	*I feel the Mental Health Staff understands my needs about: Yes Ethnic/Culture	Yes Age	Yes Disability	Yes Sexual Minority Status
No	No Ethnic/Culture	No Age	No Disability	No Sexual Minority Status
Does Not Apply	Does Not Apply Ethnic/Culture	Does Not Apply Age	Does Not Apply Disability	Does Not Apply Sexual Minority Status

12. I was treated with respect and dignity:

I was treated with respect and dignity: Yes

13. My confidentiality was respected:

My confidentiality was respected: Yes

14. Please give us comments or suggestions:

Please give us comments or suggestions:

15. We would be happy to give you a response to your specific questions, suggestion, or comments. Please give us your name, address or phone number.

We would be happy to give you a response to your specific questions, suggestion, or comments. Please give us your name, address or phone number.

THANK YOU FOR COMPLETING THIS SURVEY. YOUR FEEDBACK IS IMPORTANT.

CLIENT SURVEYExit this survey

1. I took part in choosing which services I would receive:

2. The services I receive help me with my problems:

3. I am happy with the services I receive

4. The location where I received Mental Health services was good.

5. I was happy with the waiting time between when I was first contacted by the Center and when I actually was seen:

6. Have you used our Crisis Services?

7. I used crisis services:

8. The crisis services provided were helpful to me:

9. The clinical staff answered my questions about psychotropic medication: (e.g. anti-depressants)

10. Counseling Services has helped me get or referred me to obtain Food, Medical Treatment, Housing or Legal services.

11. I feel the Mental Health Staff understands my needs about:

12. I was treated with respect and dignity:

13. My confidentiality was respected:

14. Please give us comments or suggestions:

15. We would be happy to give you a response to your specific questions, suggestion, or comments. Please give us your name, address or phone number.

CLIENT SURVEY
Exit this survey