Stakeholder Feedback Survey for Smith Community Mental Health

About You

The feedback we receive from persons throughout our community is something we take seriously in our efforts to improve our organization. We value your input and welcome your honesty in completing this community stakeholder survey.

Please complete our survey by selecting an answer below each question that best communicates your opinion. After completing the questions, please provide additional comments and suggestions in the space provided. This survey is estimated to take 4 minutes. Thank you for your time!

3.Which below describes your gender best?

Male

Female

Transgender

Prefer not to say.

4.Which below best describes best the number of years you have known about this organization?

5.Are you employed in an organization that refers persons to our services?

Yes

6.If Yes, Please select the Type/Focus of your organization that most applies:

7.What was your relationship with persons who have participated in our services:

I have, or have had, a family member, friend, acquaintance, or a professional client who has participated in your services.

I have not had a direct relationship with anyone who has participated in your services.

8.When contacting us by phone or email, our response is received in a prompt and courteous manner.

Other (please specify)

9.Our employees return phone calls and/or answer email messages in a timely manner.

Other (please specify)

10.Requests for information about our services, or about an individual receiving services, are responded to in a timely manner.

Other (please specify)

11.I have been treated with respect each time I have had contact with your organization.

Other (please specify)

12.Persons who request services, and meet the requirements for admission to a program, are admitted in a timely manner.

Other (please specify)

13.Our organization treats all persons participating in services with respect.

Other (please specify)

14.Our employees are sensitive to differences in the cultural backgrounds of the persons receiving services.

Other (please specify)

15.Our organization encourages, and is open to feedback about the quality of our services.

Other (please specify)

16.Our organization is highly respected throughout the community for providing quality services.

Other (please specify)

17.I would recommend your organization's services to a family member or friend, without hesitation.

Other (please specify)

18.Please provide any specific suggestions you may have for improving our organization and our services:

19.Please provide any additional comments you may have related to your experience with our organization: