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* 1. What county do you generally work from?

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* 2. Which of the following best describes your current occupation?

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* 3. How did you hear about Four County?

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* 4. Overall, I am satisfied with the service Four County provides to my clients.

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* 5. Written and/or verbal clinical communications from our clinicians are informative and helpful.

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* 6. Staff are helpful and professional.

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* 7. The referral process is easy to understand and hassle free.

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* 8. When I call the office, the phone is answered promptly.

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* 9. I am satisfied with how quickly the person(s) I refer are able to start services.

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* 10. I will continue to refer people to Four County.

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* 11. People I have referred have received high quality treatment.

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* 12. What other facilities do you refer people to for mental health services?

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* 13. How would you rate your overall satisfaction with our agency?

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* 14. Please give us any suggestions that you can think of to improve your experience as a referral source to Four County.

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* 15. Please leave us your email address so that we can add you to our monthly newsletter.

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