This survey is provided to help Westbrook Health Services gauge the referrer's impression of our services. Your answers are confidential and are only used to evaluate and improve the programs we offer. We appreciate your taking the time to respond candidly to our questions and in helping us to improve our services to the community.

1. What is your opinion of this statement?

  Strongly Agree Agree Neutral Disagree Strongly Disagree
Westbrook's services are equal to that of any behavioral health provider in our region.

2. How would you rate your satisfaction with Westbrook's different service options?

  Very Satisfied Satisfied Neutral Dissatisfied NA/Unsure
a) Detox and Residential Substance Abuse (Amity)
b) Outpatient Substance Abuse
c) Developmental Disabilities (MRDD)
d) Children and Family Services
e) Physician Services
f) Adult Mental Health Services
g) Crisis Care Coordination
h) Adult Crisis Stabilization
i) Psychological Testing and Evaluation

3. Of the following characteristics, how much emphasis do you place on each one when deciding where to refer a client?

  None A Little Some A Great Deal
a) Agency personnel
b) Available programs
c) Expertise with specific diagnoses
d) Client preferences
e) Client insurance
f) Agency Reputation
g) Speed in seeing client

4. How would you rate Westbrook Health Services in terms of the following dimensions?

  Poor Fair Good Very Good Excellent
a) Convenience of Locations
b) Responsiveness of Staff
c) Hours of Operation
d) Facility Cleanliness and Comfort
e) Range of Services
f) Parking and Accessibility
g) Professionalism of Staff

5. How would you characterize your satisfaction with Westbrook's services?

  Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied
a) Westbrook's care of your client
b) Benefits client received from treatment
c) Communication regarding treatment process
d) Communication regarding treatment plan
e) Access to admission/referral process
f) Efficiency of referral process
g) Communication regarding discharge planning

6. Would you refer another consumer to Westbrook Health Services?

7. Which clinical services do you feel are most in need in our community?

  Critical Need Significant Need Moderate Need Minimal Need No Need
a) Psychiatrist Availability
b) Psychological Testing and Evaluation
c) Specialized Children Assessment and Treatment (e.g., Autism, Asperger's)
d) Inservices or Workshops on Behavioral Health Issues
e) Crisis or Intensive Services for Children/Adolescents
f) Substance Abuse Services
g) Treatment for Eating Disorders

8. What other resources do you use to meet the behavioral health needs of your consumers? (please select all that apply)

9. Are there any recommendations or suggestions you might offer Westbrook to assist in our efforts to provide quality healthcare to our community?

10. We would appreciate your sharing contact information with our agency so we may reach you to discuss any concerns you may have.