Skip to content

2024 Adult Satisfaction Survey

In order to provide the best mental health services possible, we’d like to know what you think about the services you have received during the last six months, the people who provided these services to you, and the results that have been achieved. There are no right or wrong answers to the questions in this survey. Please indicate your agreement or disagreement with each of the following statements by circling the answer that best represents your opinion. If a question does not apply to you, then circle “NA” for “Not Applicable.” Your answers will remain strictly confidential.
1.Circle/Select the program you are providing feedback for:
2.I like the services that I received.
3.If I had other choices, I would still choose to get services from this agency.
4.I would recommend this agency to a friend or family member.
5.The location of services was convenient.
6.Staff were willing to see me as often as I felt it was necessary.
7.Staff returned my calls within 24 hours.
8.Services were available at times that were good for me.
9.I was able to get all the services I thought I needed.
10.I was able to see a psychiatrist/prescriber when I wanted to.
11.Staff believed that I could grow, change and recover.
12.I felt comfortable asking questions about my treatment, services and medication.
13.I felt free to complain.
14.I was given information about my rights.
15.Staff encouraged me to take responsibility for how I live my life.
16.Staff told me what side effects to watch for. (Choose NA if you are not prescribed medication)
17.Staff respected my wishes about who is and who is not to be given information about my treatment services.
18.I, not staff, decided my treatment goals.
19.Staff were sensitive to my cultural/ethnic background (e.g., race, religion, language, etc.).
20.Staff helped me obtain the information I needed so that I could take charge of managing my illness and/or disability.
21.I was encouraged to use consumer run programs (support groups, drop-in centers, crisis phone line, etc.).
As a direct result of the services I received:
22.I deal effectively with daily problems.
23.I am able to manage my life.
24.I am able to deal with crisis.
25.I am getting along with my family.
26.I am able to get along in social situations.
27.I do better in school and/or work. (Choose NA if you are not working or attending school)
28.I am satisfied with my housing situation.
29.My symptoms are not bothering me as much.
30.I do things that are more meaningful to me.
31.I am able to take care of my needs.
32.I am better able to handle things when they go wrong.
33.I am able to do things that I want to do.
For questions 34-37 please answer for relationships with persons other than your mental health provider(s).
34.I am happy with the friendships I have.
35.I have people with who I can do enjoyable things.
36.I feel I belong in my community.
37.In a crisis, I would have the support I need from family or friends.
38.How long have you been receiving services?
39.Which of the following best describes your ethnicity?
40.Which of the following best describes your race?
41.Sex assigned at birth
42.Did someone assist you in completing this survey?
43.Additional Comments
44.Do you wish to be contacted to follow up on any of your survey responses?
45.If Yes, Contact Name and Number