Please provide your thoughts about NBWC providers, your care and support, your mobility, and our quality of service we provided for you.

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* 1. (Optional) Contact Information

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* 2. Do you have weekly appointments with your provider?

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* 3. Is your provider punctual?

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* 4. Does your provider cancel or reschedule appointments frequently?

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* 5. How would you rate the professionalism and competence of your clinician and/or advocates?

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* 6. Did you receive a detailed explanation of the services and the role of the provider during the first session?

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* 7. How well did your clinician and/or advocate do when assessing your health care needs?

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* 8. Is your provider sensitive to your culture and beliefs?

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* 9. Has the provider made any referrals to provide support? (Ex; medication management, Therapeutic Mentor, OP, IHT, group therapy, etc.). 

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* 10. Do you feel the provider answers any questions that you have regarding referrals and other services?

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* 11. Overall, how would you rate your satisfaction with our teletherapy system?

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* 12. Did your provider discuss and explain to you the legal consents during the first session?

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* 13. Do you feel your provider has a clear understanding of your needs?

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* 14. Please rate the clarity of the clinician and/or advocate explanation of your treatment option and goals?

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* 15. Do you feel your treatment goals are being met?

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* 16. Did your provider discuss and explain to you the safety plan?

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* 17. Do you think your provider and/or team attends to your needs in a timely manner?

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* 18. When calling the office, is the phone answered quickly?

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* 19. Are they polite and courteous?

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* 20. When leaving a message is the provider quick to call back?

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* 21. Do you feel your providers are helpful?

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* 22. Are you overall satisfied with the services you are receiving?

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* 23. Will you recommend our services?

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* 24. If Unhappy, do you know how to make a complaint?

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* 25. What can we change to give you a better service?

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* 26. Questions 25 and on only apply to Clients receiving IHT/TTS and TM services.  If you do NOT receive these services please select N/A for each question and submit.

Which services do you receive? Choose all that apply. 

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* 27. Do you meet with your team at least once a month?

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* 28. Did your provider discuss and sign with you the consent to transport a minor?

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* 29. Do you feel the minor is safe when being transported?

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* 30. Does the provider communicate with you when the client is being picked up or dropped off at the house?

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