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SBH Member Satisfaction Survey
We would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Thank you for your time!
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1.
Your Age
(Required.)
*
2.
Your Sex
(Required.)
Male
Female
Transgender
Decline to Answer
*
3.
Your Race/Ethnicity
(Required.)
Asain
Black/African American
Native American/Alaska Native
White/Caucasian (Not Hispanic or Latino)
Hispanic or Latino (All Races)
Pacific Islander
Other:
*
4.
Your language preference
(Required.)
Primary Language
Secondary Language
*
5.
Your Insurance Type
(Required.)
Silver Summit Medicaid
Other:
*
6.
What services have you received or are receiving? (Select all services that apply).
(Required.)
Talk Therapy
Medication Management
Substance Abuse Treatment
Psychiatric Evaluation
Mobile Assessment / Receiving Center Services
Case Management
