The mission of Sandhills Center, a Local Management Entity - Managed Care Organization, is to develop, manage, and assure that persons in need have access to quality mental health, intellectual/developmental disabilities, and substance abuse services.  We are conducting a needs assessment to identify the gaps in the behavioral health services you receive.

Please take a few minutes to complete this brief survey.  Your responses are very important in helping us better serve you.  Please return your completed survey to your service provider by January 31, 2017, or mail to Sandhills Center, 201 N. Eugene, Suite A, Greensboro, NC 27401; or email it to providerhelpdesk@sandhillscenter.org, or fax to 336-389-6127.

Note: The approximate time to complete is only 3-5 minutes. All respondents will be anonymous. Any question delineated with an * requires an answer to proceed through the survey.

* 1. In what county do you receive services? (Please select all that apply.)

* 2. Which of the following services do you or your family member receive? (Please select all that apply.)

* 3. Are you getting the services you need?

* 4. If not, what services do you need that you're not getting?

* 5. With what gender do you identify?

* 6. How old are you?  ______years

* 7. What is your marital status?

* 8. What is your ethnicity?

* 9. What is your race? Please select all that apply.

* 10. What is your religious preference or spiritual tradition? (Please select all that apply.)

* 11. What is the primary language you speak at home? (Please choose only one.)

* 12. Are you able to receive services in the language in which you are most comfortable communicating?

* 13. Which of the following categories describes a population you could represent? Select 'N/A' if none of the categories apply. (Please check all that apply)

* 14. Please provide any additional feedback that you would like to give us.

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