Stakeholder Input/Feedback
1.
Check all that apply.
School Administrator
Mental Health Provider
School Counselor
Head Start Staff
Teacher
Court Officer
CPS Staff/Foster Care Staff
Other and/or Name and Agency (optional)
2.
Satisfaction with access to services through the referral process.
Extremely Dissatisfied
1 star
Dissatisfied
2 stars
Satisfied
3 stars
Extremely Satisfied
4 stars
3.
Satisfaction with the services provided by substance abuse professional(s) and/or therapist.
Extremely Dissatisfied
1 star
Dissatisfied
2 stars
Satisfied
3 stars
Extremely Satisfied
4 stars
4.
Satisfaction with any interaction with office personnel.
Extremely Dissatisfied
1 star
Dissatisfied
2 stars
Satisfied
3 stars
Extremely Satisfied
4 stars
5.
Satisfaction with the amount of time to wait for the FIRST appointment after a referral was made.
Extremely Dissatisfied
1 star
Dissatisfied
2 stars
Satisfied
3 stars
Extremely Dissatisfied
4 stars
6.
Satisfaction with the number of follow-up appointments (number/amount of times clients are seen).
Extremely Dissatisfied
1 star
Dissatisfied
2 stars
Satisfied
3 stars
Extremely Dissatisfied
4 stars
7.
Confidentiality is maintained.
Extremely Dissatisfied
1 star
Dissatisfied
2 stars
Satisfied
3 stars
Extremely Satisfied
4 stars
8.
The condition, symptoms, or complaints of those referred is improved.
Extremely Dissatisfied
1 star
Dissatisfied
2 stars
Satisfied
3 stars
Extremely Dissatisfied
4 stars
9.
Using any number from 1 to 10, where 1 is the worst mental health care possible and 10 is the best mental health/substance abuse treatment possible, choose the number you would use to rate all from our agency.
1 star
2 stars
3 stars
4 stars
5 stars
6 stars
7 stars
8 stars
9 stars
10 stars
10.
Please add any other comments you wish to share about your experience.
Current Progress,
0 of 10 answered