AMHC's Children's Behavioral Health Home Services

We would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Your feedback is an important part of our quality improvement process. The survey forms have no names and are confidential. For each statement below, check the answer that best matches your experience.

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* 1. Race/Ethnicity:

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* 2. What is your Age?

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* 3. My treatment is driven by my decisions and needs.

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* 4. I have a choice in the services I receive.

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* 5. I feel supported in reaching my goals.

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* 6. My BHH providers gives me valuable feedback about my progress.

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* 7. My appointments are scheduled at a time that is convenient for me.

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* 8. When I ask questions, my BHH providers answers in a way I can understand and is respectful.

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* 9. It was easy to set up an appointment with my provider.

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* 10. My BHH providers are on time for my appointments.

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* 11. I am treated with courtesy and respect.

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* 12. To the best of my knowledge, my personal information has been kept confidential.

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* 13. How satisfied are you with your BHH team?

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* 14. If you have experienced abuse or violence, would you feel comfortable talking about it with your BHH providers?

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* 15. Would you tell your provider about threats to your safety?

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* 16. Overall I am satisfied with the services I receive.

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* 17. I would recommend this service to others.

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* 18. In general, how would you rate your overall physical health?

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* 19. In general, how would you rate your overall mental health?

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* 20. What do you like best about our center?

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* 21. What do you like least about our center?

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* 22. PLEASE TELL US HOW YOU THINK WE CAN IMPROVE TO SERVE YOU BETTER

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