Mental Health Service Consumer Survey Form
Please share your feedback to help us improve mental health services. This form is anonymous and does not collect any sensitive personal information.
How satisfied are you with the overall quality of the mental health services you received?
*
1
2
3
4
5
How easy was it to access our mental health services?
*
Very Difficult
1
2
3
4
Very Easy
5
1 is Very Difficult, 5 is Very Easy
Please rate the professionalism and courtesy of our staff.
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
How well did our staff listen to your concerns?
*
Not at all
1
2
3
4
Extremely well
5
1 is Not at all, 5 is Extremely well
How satisfied are you with the communication you received about your care and treatment options?
*
Very Dissatisfied
1
2
3
4
Very Satisfied
5
1 is Very Dissatisfied, 5 is Very Satisfied
Please indicate your agreement with the following statements.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The services met my needs
1
2
3
4
5
I felt respected by the staff
6
7
8
9
10
I had input into decisions about my care
11
12
13
14
15
Did you experience any barriers to receiving services?
*
No
Yes
If yes, please describe the barriers you experienced.
How likely are you to recommend our mental health services to others?
*
Not at all likely
1
2
3
4
Extremely likely
5
1 is Not at all likely, 5 is Extremely likely
Please share any additional comments or suggestions.
Submit Feedback
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