Client Satisfaction Survey
1.
Who received the services from Seasons?
Self
Family Member
Other (please specify)
2.
Client Age Group
5-12
13-17
18-65
65+
3.
What services were received? Check all that apply.
Outpatient Psychiatry
Crisis Services | Crisis Stabilization
Counseling | Therapy Services
H.E.A.L. | Trauma Therapy
Assertive Community Treatment (ACT)
Substance Use Disorder Counseling
BHIS
Intensive Psychiatric Rehabilitation (IPR) Services
Nursing
Peer Support
Care Coordination | Case Management
Respite Services (including Camp Autumn)
School-Based Services
4.
Where was the appointment?
Autumn's Center
Camp Autumn
Carroll
Emmetsburg
Family Support Center
Rock Rapids
Sheldon
Sibley
Sioux Center
Sioux City
Spencer Main Office
Spirit Lake
Storm Lake
Schools
5.
If the location was a school, which school?
Algona
Clay Central-Everly
Cherokee
Emmetsburg
Laurens Marathon
MMCRU
OA-BCIG
Sioux Central
South Calhoun County
N/A
6.
The appointment was able to be made within a reasonable timeframe.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
Additional Comments:
7.
Type of preferred appointment reminder method (Check all that apply).
Phone Call
Text
Email
Would not like to be reminded
8.
Preferred timeframe for reminder of appointments.
24 hours prior
48 hours prior
72 hours prior
No reminder preferred
9.
The facility was welcoming.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
Additional Comments:
10.
The staff was friendly and helpful.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
Additional Comments:
11.
The provider was prepared for the appointment.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
Additional Comments:
12.
The provider listened to your concerns.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
Additional Comments:
13.
The provider helped with your concerns.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
Additional Comments:
14.
You would recommend your provider(s) to a friend or family member.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
Additional Comments:
15.
Using any number from 1 to 5, where 1 is the worst experience possible and 5 is the best experience possible, what number would you use to rate your experience at Seasons Center?
1 star
2 stars
3 stars
4 stars
5 stars
Additional Comments:
Current Progress,
0 of 15 answered