TBHS Member Satisfaction with Provider

1.

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We want to know what you think! Your input into this process is very important as we strive to improve our services and supports. Your answers will be kept confidential. Thank you very much for responding to this survey! If you have any questions about the survey, please contact the Quality Management Department: 1700 S. Lamar, Suite 104, Room 35, or call 440-4046

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* 1. Which Tejas provider are you, or your child currently seeing?

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* 2. How satisfied are you with the following:

	Very Satisfied	Somewhat Satisfied	Somewhat Dissatisfied	Very Dissatisfied	Does not apply
Quality of services you, or your child, have received	Quality of services you, or your child, have received Very Satisfied	Quality of services you, or your child, have received Somewhat Satisfied	Quality of services you, or your child, have received Somewhat Dissatisfied	Quality of services you, or your child, have received Very Dissatisfied	Quality of services you, or your child, have received Does not apply
The amount of help and services you, or your child, have received	The amount of help and services you, or your child, have received Very Satisfied	The amount of help and services you, or your child, have received Somewhat Satisfied	The amount of help and services you, or your child, have received Somewhat Dissatisfied	The amount of help and services you, or your child, have received Very Dissatisfied	The amount of help and services you, or your child, have received Does not apply
The overall services you, or your child, have received	The overall services you, or your child, have received Very Satisfied	The overall services you, or your child, have received Somewhat Satisfied	The overall services you, or your child, have received Somewhat Dissatisfied	The overall services you, or your child, have received Very Dissatisfied	The overall services you, or your child, have received Does not apply
The location of the services	The location of the services Very Satisfied	The location of the services Somewhat Satisfied	The location of the services Somewhat Dissatisfied	The location of the services Very Dissatisfied	The location of the services Does not apply
The staff that provided the services	The staff that provided the services Very Satisfied	The staff that provided the services Somewhat Satisfied	The staff that provided the services Somewhat Dissatisfied	The staff that provided the services Very Dissatisfied	The staff that provided the services Does not apply

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* 3. Do you agree, or disagree with the following:

	Strongly Agree	Agree	Disagree	Strongly Disagree	Does not apply
I, or my child, has received the kind of services I wanted.	I, or my child, has received the kind of services I wanted. Strongly Agree	I, or my child, has received the kind of services I wanted. Agree	I, or my child, has received the kind of services I wanted. Disagree	I, or my child, has received the kind of services I wanted. Strongly Disagree	I, or my child, has received the kind of services I wanted. Does not apply
This provider has met mine, or my child's, needs.	This provider has met mine, or my child's, needs. Strongly Agree	This provider has met mine, or my child's, needs. Agree	This provider has met mine, or my child's, needs. Disagree	This provider has met mine, or my child's, needs. Strongly Disagree	This provider has met mine, or my child's, needs. Does not apply
I would recommend this provider to another individual.	I would recommend this provider to another individual. Strongly Agree	I would recommend this provider to another individual. Agree	I would recommend this provider to another individual. Disagree	I would recommend this provider to another individual. Strongly Disagree	I would recommend this provider to another individual. Does not apply
I would continue to use this provider if given other choices.	I would continue to use this provider if given other choices. Strongly Agree	I would continue to use this provider if given other choices. Agree	I would continue to use this provider if given other choices. Disagree	I would continue to use this provider if given other choices. Strongly Disagree	I would continue to use this provider if given other choices. Does not apply
The provider was willing to see me, or my child, as often as felt necessary.	The provider was willing to see me, or my child, as often as felt necessary. Strongly Agree	The provider was willing to see me, or my child, as often as felt necessary. Agree	The provider was willing to see me, or my child, as often as felt necessary. Disagree	The provider was willing to see me, or my child, as often as felt necessary. Strongly Disagree	The provider was willing to see me, or my child, as often as felt necessary. Does not apply
Services were available at times that were good for me.	Services were available at times that were good for me. Strongly Agree	Services were available at times that were good for me. Agree	Services were available at times that were good for me. Disagree	Services were available at times that were good for me. Strongly Disagree	Services were available at times that were good for me. Does not apply
I, or my child, was able to get the services needed.	I, or my child, was able to get the services needed. Strongly Agree	I, or my child, was able to get the services needed. Agree	I, or my child, was able to get the services needed. Disagree	I, or my child, was able to get the services needed. Strongly Disagree	I, or my child, was able to get the services needed. Does not apply
I, or my child, was able to see the provider when I wanted.	I, or my child, was able to see the provider when I wanted. Strongly Agree	I, or my child, was able to see the provider when I wanted. Agree	I, or my child, was able to see the provider when I wanted. Disagree	I, or my child, was able to see the provider when I wanted. Strongly Disagree	I, or my child, was able to see the provider when I wanted. Does not apply
I, or my child, felt comfortable asking questions about the treatment and medication.	I, or my child, felt comfortable asking questions about the treatment and medication. Strongly Agree	I, or my child, felt comfortable asking questions about the treatment and medication. Agree	I, or my child, felt comfortable asking questions about the treatment and medication. Disagree	I, or my child, felt comfortable asking questions about the treatment and medication. Strongly Disagree	I, or my child, felt comfortable asking questions about the treatment and medication. Does not apply
I felt free to voice my concerns to the provider.	I felt free to voice my concerns to the provider. Strongly Agree	I felt free to voice my concerns to the provider. Agree	I felt free to voice my concerns to the provider. Disagree	I felt free to voice my concerns to the provider. Strongly Disagree	I felt free to voice my concerns to the provider. Does not apply
I participated in the treatment plan, and choosing treatment goals.	I participated in the treatment plan, and choosing treatment goals. Strongly Agree	I participated in the treatment plan, and choosing treatment goals. Agree	I participated in the treatment plan, and choosing treatment goals. Disagree	I participated in the treatment plan, and choosing treatment goals. Strongly Disagree	I participated in the treatment plan, and choosing treatment goals. Does not apply
Staff treated me with respect.	Staff treated me with respect. Strongly Agree	Staff treated me with respect. Agree	Staff treated me with respect. Disagree	Staff treated me with respect. Strongly Disagree	Staff treated me with respect. Does not apply
Staff respected my family's religious/spiritual beliefs.	Staff respected my family's religious/spiritual beliefs. Strongly Agree	Staff respected my family's religious/spiritual beliefs. Agree	Staff respected my family's religious/spiritual beliefs. Disagree	Staff respected my family's religious/spiritual beliefs. Strongly Disagree	Staff respected my family's religious/spiritual beliefs. Does not apply
Staff spoke with me in a way that we understood.	Staff spoke with me in a way that we understood. Strongly Agree	Staff spoke with me in a way that we understood. Agree	Staff spoke with me in a way that we understood. Disagree	Staff spoke with me in a way that we understood. Strongly Disagree	Staff spoke with me in a way that we understood. Does not apply
Staff was sensitive to our cultural/ethnic background.	Staff was sensitive to our cultural/ethnic background. Strongly Agree	Staff was sensitive to our cultural/ethnic background. Agree	Staff was sensitive to our cultural/ethnic background. Disagree	Staff was sensitive to our cultural/ethnic background. Strongly Disagree	Staff was sensitive to our cultural/ethnic background. Does not apply

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* 4. As a result of services...

	Strongly Agree	Agree	Disagree	Strongly Disagree	Does Not Apply
I, or my child, is better at handling life.	I, or my child, is better at handling life. Strongly Agree	I, or my child, is better at handling life. Agree	I, or my child, is better at handling life. Disagree	I, or my child, is better at handling life. Strongly Disagree	I, or my child, is better at handling life. Does Not Apply
I, or my child, is getting along better with family members.	I, or my child, is getting along better with family members. Strongly Agree	I, or my child, is getting along better with family members. Agree	I, or my child, is getting along better with family members. Disagree	I, or my child, is getting along better with family members. Strongly Disagree	I, or my child, is getting along better with family members. Does Not Apply
I, or my child, is getting along better with friends and other people.	I, or my child, is getting along better with friends and other people. Strongly Agree	I, or my child, is getting along better with friends and other people. Agree	I, or my child, is getting along better with friends and other people. Disagree	I, or my child, is getting along better with friends and other people. Strongly Disagree	I, or my child, is getting along better with friends and other people. Does Not Apply
I, or my child, is doing better in school and/or work.	I, or my child, is doing better in school and/or work. Strongly Agree	I, or my child, is doing better in school and/or work. Agree	I, or my child, is doing better in school and/or work. Disagree	I, or my child, is doing better in school and/or work. Strongly Disagree	I, or my child, is doing better in school and/or work. Does Not Apply
I, or my child, is better able to cope when things go wrong.	I, or my child, is better able to cope when things go wrong. Strongly Agree	I, or my child, is better able to cope when things go wrong. Agree	I, or my child, is better able to cope when things go wrong. Disagree	I, or my child, is better able to cope when things go wrong. Strongly Disagree	I, or my child, is better able to cope when things go wrong. Does Not Apply

TBHS Member Satisfaction with Provider

1.

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* 1. Which Tejas provider are you, or your child currently seeing?

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* 2. How satisfied are you with the following:

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* 3. Do you agree, or disagree with the following:

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* 4. As a result of services...

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* 5. Do you have comments, or suggestions for the provider?

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* 6. For Staff Purposes: