* 1. What county do you generally work from?

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

* 3. How did you hear about Four County?

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

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

* 6. Staff are helpful and professional.

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

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

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

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

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

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

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

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

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

T