Consumer Satisfaction Survey

We value your input and love to hear about your experiences with our services. Please fill out the following survey.

* Date

Date / Time
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* Person Completing The Survey

* Age range of person receiving services

* Services received at Crisis & Counseling Centers, which this survey refers to: (check only one) 

* Location of Crisis Stabilization Unit (If Applicable)

* 1. Please rate your satisfaction with how quickly you received services

* 2. Please rate whether you feel that you were treated in a welcoming and respectful manner

* 3. Please indicate whether the services you received focused on your primary concerns

* 4. Please rate whether you feel that the staff understood you and your situation

* 5. Please indicate how helpful the services you received were

* 6. Please indicate how comfortable the facilities were

* 7. Please rate your overall experience

* 8. How likely would you be to recommend our services to others

* Additional Comments

* How did you hear about our services?

* If you wish to be contacted, you may:
A) Write your clinicians first name and your appointment date and time
B) If you are leaving a CSU, enter your date of discharge, CSU location and initials. 
For confidentiality purposes, please DO NOT enter your name for any reason 

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