CLIENT SURVEY

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CLIENT SURVEY
NEW HIRE FORMS

Home
About
Appointments & Forms
Services & Staff
Employment
Contact Us
CPST Resources
- CBHC Forms
- Resources
CLIENT SURVEY
NEW HIRE FORMS

CLIENT SATISFACTION SURVEY

Your experience with CBHC is important to us. Your answers
will be kept anonymous and confidential and will only be used for internal
use to help us improve our services. Thank you!

General

Does our staff call you by name? *

Yes Sometimes No Doesn't Apply

Do you feel that your personal dignity is maintained? *

Yes Sometimes No Doesn't Apply

Do you receive satisfactory answers to your questions? *

Yes Sometimes No Doesn't Apply

Are you satisfied with the thoroughness of care you receive? *

Yes Sometimes No Doesn't Apply

Do you feel confident you are receiving treatments and medications intended for you? *

Yes Sometimes No Doesn't Apply

Do you feel there is adequate communication among our psychiatrists, counselors and CPST staff regarding your treatment? *

Yes Sometimes No Doesn't Apply

Do our psychiatrists keep you informed about your condition and your care plan? *

Yes Sometimes No Doesn't Apply

9. Are you adequately involved with decisions affecting your care? *

Yes Sometimes No Doesn't Apply

Improvment

Has the condition for which you are being treated improved? *

Yes Somewhat No Doesn't Apply

Are you satisfied with how well your condition has improved? *

Yes Somewhat No Doesn't Apply

Are you satisfied with the thoroughness of care you receive from our staff? *

Yes Somewhat No Doesn't Apply

Does our staff adequately explain your treatment to you? *

Yes Somewhat No Doesn't Apply

Would you recommend us to your friends or family? *

Yes Somewhat No Doesn't Apply

Overall, are you satisfied with your treatment? *

Yes Somewhat No Doesn't Apply

Safety

Do you feel safe in CBHC’s office? *

Yes Somewhat No Doesn't Apply

Do you feel safe in the presence of Physicians/Psychiatrists? *

Yes Somewhat No Doesn't Apply

Do you feel safe in the presence of Social Workers/Counselors? *

Yes Somewhat No Doesn't Apply

Do you feel safe in the presence of your Case Manager? *

Yes Somewhat No Doesn't Apply

Courtesy

How would you rate the courtesy of the following staff?

Psychiatrists/Nursing Care *

Social Workers/Counselors *

CPST/Case Manager *

Receptionist/ Office Staff *

Overall ratings

What is your overall opinion of:

Your Psychiatrist *

Social Worker/Councelor *

CPST/Case Manager *

The overall quality of care received *

Please tell us:

What do you like most about CBHC? *

How can we improve our service? *

How can we make our organization safer for our clients? *

How likely are you to recommend CBHC to a friend or family member? *

Do you have any additional comments or feelings you would like to express about CBHC? *

Optional:

If you would like to be contacted by a representative to discuss any aspect of your treatment, please include your name and a daytime phone number.

Name *

Phone Number *

Thank you for taking the time to help us learn how we can improve our services!

Submit

CLIENT SATISFACTION SURVEY

Your experience with CBHC is important to us. Your answerswill be kept anonymous and confidential and will only be used for internaluse to help us improve our services. Thank you!

General

Improvment

Safety

Courtesy

How would you rate the courtesy of the following staff?

Overall ratings

What is your overall opinion of:

Please tell us:

Optional:

If you would like to be contacted by a representative to discuss any aspect of your treatment, please include your name and a daytime phone number.

Thank you for taking the time to help us learn how we can improve our services!

Your experience with CBHC is important to us. Your answers
will be kept anonymous and confidential and will only be used for internal
use to help us improve our services. Thank you!