BHRS Consumer Satisfaction Survey - English Question Title * 1. Date Completed Today's Date: Date Question Title * 2. Please check the location of services received. Merced Los Banos North County - Winton Atwater Outside Merced County Question Title * 3. What type of services do you receive? Behavioral Health Substance Use Disorder Both Question Title * 4. If you receive BEHAVIORAL HEALTH services, please select the program. Adult Older Adult CNP Merced DDP Housing The NET Wellness Center Youth TAY AspiraNet Creative Alternatives Crisis Residential Unit GLOM Merced Lao Family Turning Point Adult Behavioral Health Court Juvenile Behavioral Health Court CNP-A Breaking Barriers Restart Pre-Trial MH Diversion Court Community Co-Response Team CalWORKS I do not receive Behavioral Health services. La Familia Kern Bridges Question Title * 5. If you receive SUBSTANCE USE DISORDER services, please select the program. Adult Drug Court Adult Outpatient Dependency Drug Court Youth Outpatient or RAFT Perinatal I do not receive Substance Use Disorder services. Question Title * 6. Gender: Male Female Transgender Non-Binary Agender Pangender Genderqueer Two Spirit Third Gender Gender Neutral Unknown Choose not to Disclose Other (please specify) Question Title * 7. Sexual Orientation Lesbian Gay Bisexual Asexual Pansexual Queer Straight Question Title * 8. Race/Ethnicity: American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Island White (Non-Hispanic) Other (please specify) Question Title * 9. Age: 0-15 16-25 26-59 60+ Question Title * 10. Ease of Use: Strongly Agree Agree Disagree Strongly Disagree Don't Know Does Not Apply 1. It is easy to make an appointment. 1. It is easy to make an appointment. Strongly Agree 1. It is easy to make an appointment. Agree 1. It is easy to make an appointment. Disagree 1. It is easy to make an appointment. Strongly Disagree 1. It is easy to make an appointment. Don't Know 1. It is easy to make an appointment. Does Not Apply 2. The location of services is convenient. 2. The location of services is convenient. Strongly Agree 2. The location of services is convenient. Agree 2. The location of services is convenient. Disagree 2. The location of services is convenient. Strongly Disagree 2. The location of services is convenient. Don't Know 2. The location of services is convenient. Does Not Apply 3. I am able to get all of the services I think I need. 3. I am able to get all of the services I think I need. Strongly Agree 3. I am able to get all of the services I think I need. Agree 3. I am able to get all of the services I think I need. Disagree 3. I am able to get all of the services I think I need. Strongly Disagree 3. I am able to get all of the services I think I need. Don't Know 3. I am able to get all of the services I think I need. Does Not Apply 4. Services are available at times that are good for me. 4. Services are available at times that are good for me. Strongly Agree 4. Services are available at times that are good for me. Agree 4. Services are available at times that are good for me. Disagree 4. Services are available at times that are good for me. Strongly Disagree 4. Services are available at times that are good for me. Don't Know 4. Services are available at times that are good for me. Does Not Apply 5. Staff returns my calls within 24 hours. 5. Staff returns my calls within 24 hours. Strongly Agree 5. Staff returns my calls within 24 hours. Agree 5. Staff returns my calls within 24 hours. Disagree 5. Staff returns my calls within 24 hours. Strongly Disagree 5. Staff returns my calls within 24 hours. Don't Know 5. Staff returns my calls within 24 hours. Does Not Apply Question Title * 11. Quality of Care: Strongly Agree Agree Disagree Strongly Disagree Don't Know Does Not Apply 6. I feel respected and listened to by staff. 6. I feel respected and listened to by staff. Strongly Agree 6. I feel respected and listened to by staff. Agree 6. I feel respected and listened to by staff. Disagree 6. I feel respected and listened to by staff. Strongly Disagree 6. I feel respected and listened to by staff. Don't Know 6. I feel respected and listened to by staff. Does Not Apply 7. I understand my treatment. 7. I understand my treatment. Strongly Agree 7. I understand my treatment. Agree 7. I understand my treatment. Disagree 7. I understand my treatment. Strongly Disagree 7. I understand my treatment. Don't Know 7. I understand my treatment. Does Not Apply 8. I feel comfortable asking questions about my treatment and/or medication. 8. I feel comfortable asking questions about my treatment and/or medication. Strongly Agree 8. I feel comfortable asking questions about my treatment and/or medication. Agree 8. I feel comfortable asking questions about my treatment and/or medication. Disagree 8. I feel comfortable asking questions about my treatment and/or medication. Strongly Disagree 8. I feel comfortable asking questions about my treatment and/or medication. Don't Know 8. I feel comfortable asking questions about my treatment and/or medication. Does Not Apply 9. I participate in my treatment planning. 9. I participate in my treatment planning. Strongly Agree 9. I participate in my treatment planning. Agree 9. I participate in my treatment planning. Disagree 9. I participate in my treatment planning. Strongly Disagree 9. I participate in my treatment planning. Don't Know 9. I participate in my treatment planning. Does Not Apply Question Title * 12. Outcomes: Strongly Agree Agree Disagree Strongly Disagree Don't Know Does Not Apply 10. My symptoms are not bothering me as much. 10. My symptoms are not bothering me as much. Strongly Agree 10. My symptoms are not bothering me as much. Agree 10. My symptoms are not bothering me as much. Disagree 10. My symptoms are not bothering me as much. Strongly Disagree 10. My symptoms are not bothering me as much. Don't Know 10. My symptoms are not bothering me as much. Does Not Apply 11. I am achieving my goals. 11. I am achieving my goals. Strongly Agree 11. I am achieving my goals. Agree 11. I am achieving my goals. Disagree 11. I am achieving my goals. Strongly Disagree 11. I am achieving my goals. Don't Know 11. I am achieving my goals. Does Not Apply 12. I do better in daily life. 12. I do better in daily life. Strongly Agree 12. I do better in daily life. Agree 12. I do better in daily life. Disagree 12. I do better in daily life. Strongly Disagree 12. I do better in daily life. Don't Know 12. I do better in daily life. Does Not Apply Question Title * 13. Overall Satisfaction: Strongly Agree Agree Disagree Strongly Disagree Don't Know Does Not Apply 13. I would recommend the services received at this agency to family and friends. 13. I would recommend the services received at this agency to family and friends. Strongly Agree 13. I would recommend the services received at this agency to family and friends. Agree 13. I would recommend the services received at this agency to family and friends. Disagree 13. I would recommend the services received at this agency to family and friends. Strongly Disagree 13. I would recommend the services received at this agency to family and friends. Don't Know 13. I would recommend the services received at this agency to family and friends. Does Not Apply 14. If I had other choices, I would still get services from this agency. 14. If I had other choices, I would still get services from this agency. Strongly Agree 14. If I had other choices, I would still get services from this agency. Agree 14. If I had other choices, I would still get services from this agency. Disagree 14. If I had other choices, I would still get services from this agency. Strongly Disagree 14. If I had other choices, I would still get services from this agency. Don't Know 14. If I had other choices, I would still get services from this agency. Does Not Apply 15. Comments: Thank you for telling us how we are doing! Done
