Community Health Improvement Partners Mental Health/Substance Abuse Provider Survey

Your feedback will be used to create a countywide Mental Health and Substance Abuse Resource Guide. This survey should take no more than five minutes to complete. We value your response. Thank you for your participation!  

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* 1. Organization Information

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* 2. Point of Contact Information

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* 3. What is the best way to reach the point of contact for this organization? Select all that apply.

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* 4. Does this organization currently provide Mental Health and/or Substance Abuse services to Gulf and/or Franklin County residents? Select all that apply.

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* 5. If you answered yes to Q3 above, please select the age range of the clients served. Select all that apply.

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* 6. Please indicate which county this organization currently provide services for.

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* 7. Which types of Mental Health services does this facility provide? Select all that apply.

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* 8. Which types of Substance Abuse services/resources does your facility provide? Select all that apply.

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* 9. What Insurance does your organization accept? Select all that apply.

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