Adult Survey • Range Mental Health Center

Section 1

Please indicate how much you agree or disagree with each of the following statements about the services you have received in the past SIX months by selecting the number that best represents your opinion. If the statement is about something you have not experienced, select “NA” to indicate it is not applicable to you.

I like the services that I received here.(Required)

If I had other choices, I would still get services from this agency.(Required)

I would recommend this agency to a friend or family member.(Required)

The location of services was convenient (parking, public transportation, distance, etc.).(Required)

Staff were willing to see me as often as I felt it was necessary.(Required)

Staff returned my call in 24 hours.(Required)

Services were available at times that were good for me.(Required)

I was able to get all the services I thought I needed.(Required)

I was able to see a psychiatrist when I wanted to.(Required)

Staff here believe that I can grow, change and recover.(Required)

I felt comfortable asking questions about my treatment and medication.(Required)

I feel that I can file a grievance.(Required)

I was given information about my rights.(Required)

Staff encouraged me to take responsibility for how I live my life.(Required)

Staff told me what side effects to watch out for.(Required)

Staff respected my wishes about who is and who is not to be given information about my treatment.(Required)

I, not staff, decided my treatment goals.(Required)

Staff were sensitive to my cultural background (race, religion, language, etc.)(Required)

Staff helped me obtain the information I needed so that I could take charge of managing my life.(Required)

I was encouraged to use consumer-run programs (support groups, drop-in centers, crisis phone line, etc.).(Required)

Section 2

As a direct result of the services I received in the last 6 months:

I deal more effectively with daily problems.(Required)

I am better able to control my life.(Required)

I am better able to deal with crisis.(Required)

I am getting along better with those close to me.(Required)

I do better in social situations.(Required)

I do better in school and/or work.(Required)

My housing situation has improved.(Required)

My symptoms are not bothering me as much.(Required)

What has been the most helpful thing about the services you received over the last 6 months?(Required)

What would improve the services here?(Required)

CAPTCHA

Phone

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Adult Customer Satisfaction Survey

Section 1

Section 2