Please provide your thoughts about NBWC providers, your care and support, your mobility, and our quality of service we provided for you.

Question Title

* 1. (Optional) Contact Information

Question Title

* 2. Do you have weekly appointments with your provider?

Question Title

* 3. Is your provider punctual?

Question Title

* 4. Does your provider cancel or reschedule appointments frequently?

Question Title

* 5. How would you rate the professionalism and competence of your clinician and/or advocates?

Question Title

* 6. Did you receive a detailed explanation of the services and the role of the provider during the first session?

Question Title

* 7. Does your clinician and/or advocate do well when assessing your health care needs?

Question Title

* 8. Is your provider sensitive to your culture and beliefs?

Question Title

* 9. Has the provider made any referrals to provide support? (Ex; medication management, Therapeutic Mentor, OP, IHT, group therapy, etc.). 

Question Title

* 10. Do you feel the provider answers any questions that you have regarding referrals and other services?

Question Title

* 11. Overall, Are you satisfied with our teletherapy system?

Question Title

* 12. Did your provider discuss and explain to you the legal consents during the first session?

Question Title

* 13. Do you feel your provider has a clear understanding of your needs?

Question Title

* 14. Is your clinician and/or advocate clear in their explanation of your treatment option and goals?

Question Title

* 15. Do you feel your treatment goals are being met?

Question Title

* 16. Did your provider discuss and explain to you the safety plan?

Question Title

* 17. Do you think your provider and/or team attends to your needs in a timely manner?

Question Title

* 18. When calling the office, is the phone answered quickly?

Question Title

* 19. Are they polite and courteous?

Question Title

* 20. When leaving a message is the provider quick to call back?

Question Title

* 21. Do you feel your providers are helpful?

Question Title

* 22. Are you overall satisfied with the services you are receiving?

Question Title

* 23. Will you recommend our services?

Question Title

* 24. If Unhappy, do you know how to make a complaint?

Question Title

* 25. What can we change to give you a better service?

Question Title

* 26. Questions 27 and on only apply to Clients receiving IHT/TTS and TM services. If you do NOT receive these services please select N/A for each question and submit.

Which services do you receive? Choose all that apply.

Question Title

* 27. Do you meet with your team at least once a month?

Question Title

* 28. Did your provider discuss and sign with you the consent to transport a minor?

Question Title

* 29. Do you feel the minor is safe when being transported?

Question Title

* 30. Does the provider communicate with you when the client is being picked up or dropped off at the house?

0 of 30 answered
 

T