UCLA CAPS Client Feedback Survey Question Title * 1. Who did you see? Triage Clinician Psychiatrist Therapist Trainee Group Therapist Other (please specify) Question Title * 2. Considering your experience with CAPS, how likely is it that you would recommend CAPS to someone you care about? Very Likely Likely Neutral Unliklely Very unlikely Question Title * 3. Did our team members (please select all that apply) Connect with you politely Introduce and explain their role Communicate clearly about your care Ask if you had any questions or concerns Respond to your questions or concerns Explain next steps Demonstrate cultural sensitivity All of the above None of the above Question Title * 4. Would you like to acknowledge a particular individual(s) involved with your care today? Question Title * 5. Do you have any other specific feedback or suggestions about your visit today? (In order to protect your privacy, please do not include any personal health information, this is not an encrypted site) Question Title * 6. This survey is anonymous. If you would like to be contacted, please provide your email address: Done
