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.)

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2. Your Sex (Required.)

Male

Female

Transgender

Decline to Answer

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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:

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4. Your language preference (Required.)

Primary Language

Secondary Language

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5. Your Insurance Type (Required.)

Silver Summit Medicaid

Other:

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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

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!

Question Title

* 1. Your Age (Required.)

Question Title

* 2. Your Sex (Required.)

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* 3. Your Race/Ethnicity (Required.)

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* 4. Your language preference (Required.)

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* 5. Your Insurance Type (Required.)

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* 6. What services have you received or are receiving? (Select all services that apply). (Required.)

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!

1. Your Age (Required.)

2. Your Sex (Required.)

3. Your Race/Ethnicity (Required.)

4. Your language preference (Required.)

5. Your Insurance Type (Required.)

6. What services have you received or are receiving? (Select all services that apply). (Required.)