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* 1. Location of Service (optional)

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* 2. Who provided your service? (optional)

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* 3. Please check the service(s) you receive:

Please rate the following:

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* 4. The level of professionalism and courtesy you receive from Compass Behavioral Health

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* 5. Information given to you about your diagnosis and treatment

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* 6. Your satisfaction with the overall quality of services you receive

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* 7. The scheduling of your appointments (ease, timeliness, accessibility)

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* 8. Our billing or business procedures were explained well and easy to understand

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* 9. Your satisfaction with the overall help you are receiving

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* 10. If you have received televideo services, please rate your experience

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* 11. How can we improve our services? What can we do better? Are there any other services you would like to see us offer?

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* 12. Are you aware of the complaint and grievance process, if needed?

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* 13. Other comments or suggestions:

For information related to this survey or the complaint and grievance process, please contact Tiffany Burrows, Quality Improvement Manager, at tburrows@compassbh.org or 620-275-0644.

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