We want to continue to improve the services we provide and be responsive to client feedback.  Please help us by checking the box that best reflects your opinion about the services you have received.  All responses are confidential. Your answers are important to us.

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* 1. Name of Provider (please complete separate surveys if you have multiple providers):

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* 2. I was able to get in for my first appointment within a reasonable amount of time.

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* 3. I am able to make same day appointments when needed.

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* 4. Agency hours work for me.

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* 5. My information is kept private.

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* 6. My provider’s office/group room is clean and comfortable.

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* 7. I helped set treatment goals and reviewed them throughout the treatment process.

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* 8. You may need other services that we do not provide. Have we helped you find other services you need?

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* 9. My provider considers my personal and family beliefs.

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* 10. My provider listens to me.

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* 11. I am treated with respect by my provider.

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* 12. My treatment is helping.

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* 13. I would recommend CMMHC to a friend or family member in need of similar help.

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* 14. Would you like to expand on any of the answers above?

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* 15. What one thing could we do to make your visit with us better?

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