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* 1. Your general impression of the Behavioral Health Department is:

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* 2. Would you recommend Behavioral Health and our practitioners to your relatives and friends?

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* 3. How close to your scheduled appointment time were you seen?

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* 4. If you had to wait longer than 20 minutes, were you informed of the reason?

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* 5. After contacting Behavioral Health for an initial appointment, how long did you have to wait before you were seen?

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* 6. Was your time spent with your practitioner meaningful for you?

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* 7. Please rate the following areas as it relates to your experience with our practitioners.

  Excellent Good Fair Poor
Friendliness
Professionalism
Respectful
Knowledgeable

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* 8. Please rate the following areas as it relates to your experience with our office/support employees.

  Excellent Good Fair Poor
Friendliness
Professionalism
Respectful
Knowledgeable

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* 9. Please rate the following areas as it relates to our facility.

  Excellent Good Fair Poor
Cleanliness
Privacy
Comfort
Appearance
Safety

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* 10. What has been positive about your time spent in our department?

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* 11. How can we make your experience better in the future?

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