Voluntary Client Survey
1.
Which area are your services based in?
Lynchburg
Martinsville
New River Valley
Roanoke
2.
What services do you participate in? (Check all that apply)
Mental Health Skill-Building
Partial Hospitalization (PHP)
Intensive Outpatient (IOP)
SA/MH Outpatient Counseling
Peer Recovery Services
Case Management
Medication Assisted Treatment
3.
How many days a week do you receive services from ehs?
1
2
3
4
5
6
7
4.
Do you feel this is enough time based on your needs?
Yes
No
5.
Do you understand your goals you are working on in services?
Yes
No
6.
Do office staff (directors, program managers, team leaders, clinical coordinators, office managers) take your concerns seriously and resolve them timely?
Yes
No
7.
If no, please comment:
8.
Do you feel ehs staff treat you with respect at all times?
Yes
No
9.
If no, please comment:
10.
Do your services/appointments start on time, as scheduled?
All of the time
Most of the time
Rarely
Never
11.
Does your clinician/counselor/case manager/peer recovery specialist call you ahead of time if there is a change in schedule?
All of the time
Most of the time
Rarely
Never
12.
Do you feel like you are making progress on your goals in services?
Yes
No
13.
Do you feel like ehs cares about providing you with quality services?
Yes
No
14.
What more could ehs do to improve your services with us?
15.
Would you like an ehs staff person to contact you regarding this survey?
Yes
No
16.
Name
17.
Phone Number
*
18.
Privacy
(Required.)
Yes, you may share my answers with the staff of the office where I receive services.
No, you may not share my answers with the staff of the office where I receive services.
Current Progress,
0 of 18 answered
