Consumer Satisfaction Survey

We value your input and love to hear about your experiences with our services. Please fill out the following survey.

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* Date

Date

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* Person Completing The Survey

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* Age range of person receiving services

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* Services received at Crisis & Counseling Centers, which this survey refers to: (check only one)

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* Location of Crisis Stabilization Unit (If Applicable)

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* 1. Please rate your satisfaction with how quickly you received services

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* 2. Please rate whether you feel that you were treated in a welcoming and respectful manner

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* 3. Please indicate whether the services you received focused on your primary concerns

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* 4. Please rate whether you feel that the staff understood you and your situation

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* 5. Please indicate how helpful the services you received were

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* 6. Please indicate how comfortable the facilities were

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* 7. Please rate your overall experience

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* 8. How likely would you be to recommend our services to others

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* Additional Comments

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* How did you hear about our services?

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* If you wish to be contacted, you may:
A) Write your clinician/case managers first name and your appointment date and time
B) If you are leaving a CSU, enter your date of discharge, CSU location and initials.
For confidentiality purposes, please DO NOT enter your name for any reason

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