Creative Spirits Client Satisfaction Survey

Creative Spirits Behavioral Health Client Satisfaction Survey

We would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Your responses are directly responsible for improving these services. All responses will be kept confidential and anyonymous. Thank you for your time.
Your Age:
Your Sex:

MaleFemaleTransgender
Your Race/Ethnicity:

American Indian/Alaska NativeAsianBlack/African AmericanHispanic or Latina (All Races)Pacific IslanderWhite (Non Hispanic or Latino)Unknown
Please mark how well you think we are doing in the following areas:

Ease of Getting Care:

Waiting:

	Great	Good	Okay	Fair	Poor
Time in Waiting Room (Virtual or In-Person)
Time in Therapy Session
Waiting for Assessment to be Performed
Waiting for Assessment Results

Staff: Providers (Therapists, Case Managemer, Peer Support Specialist)

	Great	Good	Okay	Fair	Poor
Listens to You
Takes enough time with You
Explains What You Want to Know
Gives you Good Advice and Treatment

Staff: Intake Specialists and Office Staff

	Great	Good	Okay	Fair	Poor
Friendly and Helpful to You
Answers Your Questions

Staff: All Others

	Great	Good	Okay	Fair	Poor
Friendly and Helpful to You
Answers Your Questions

Payment:

Facility:

	Great	Good	Okay	Fair	Poor
Neat and Clean Building
Ease of Finding Where to Go
Comfort and Saety While Waiting
Privacy

Confidentiality

	Great	Good	Okay	Fair	Poor
Keeping Your Personal Information Private

Source of Care:

	Great	Good	Okay	Fair	Poor
The Likelihood of Referring Your Friends and Relaives to Us

Do You Consider This Center Your Regular Source of Care?

YesNo
What do you like best about our center?
What do you like least about our center?
Suggestions for Improvement?
Thank you for your feedback!

With your help, we seek to provide the best possible services
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Creative Spirits Behavioral Health Client Satisfaction Survey