Maine CBS Survey
Thank you for your valuable feedback. The voluntary demographic questions at the end of this survey help us ensure we deliver care in an equitable and non-discriminatory fashion.
1.
Are you satisfied with your care?
Poor
1 star
Needs Improvement
2 stars
Fair
3 stars
Very Good
4 stars
Great
5 stars
2.
How easy is it to make an appointment or talk with a representative?
Very Tough
1 star
Tough
2 stars
Satisfactory
3 stars
Easy
4 stars
Very Easy
5 stars
3.
Are the therapists and staff compassionate and caring?
Not All
1 star
Needs Improvement
2 stars
Fairly
3 stars
Yes
4 stars
Therapists are very warm and caring towards me
5 stars
4.
Do therapists and staff involve you in your treatment planning and goals?
Not at all
1 star
Rarely
2 stars
Sometimes
3 stars
Mostly
4 stars
Always
5 stars
5.
How likely are you to refer a friend or family?
Not at all
1 star
Would definitely refer
2 stars
6.
What are we doing well?
7.
What can we do better?
8.
How can we improve client safety?
9.
What is your age?
Under 10 years
11-17 years
18-64 years
65 years or older
10.
What is your identified gender?
Male (cisgender)
Female (cisgender)
Transgender Male
Transgender Female
Genderqueer
Other identification
Decline to specify
11.
What is your racial or ethnic identity? (you may select more than one)
American Indian or Alaska Native
Asian or Asian American
Black or African American
Native Hawaiian or Pacific Islander
White or Caucasian
Hispanic or Latino
Another race/ethnic group
Decline to specify