Customer Satisfaction Survey

If you or a loved one recently received services funded by the Mental Health & Recovery Board, we would appreciate your feedback on the care you experienced. Your feedback will help us learn what you liked and what we can do to better meet our community's needs.

Please answer the following questions and hit the "submit" button when you have completed the survey. If you would like to receive a reply, please include your contact information.

Who recieved services?
Me
Loved One
Other

Which Mental Health & Recovery Board agency provided the services?
Coleman Professional Services
Townhall II
Children's Advantage
Family and Community Services Inc.
Compass Recovery
The Bair Foundation

What service or services did you receive 

Were you able to get first appointment in a reasonable amount of time?
Yes
No
If not, how long did you wait?
One Month
Two Months
More Than Two Months

Was the waiting time reasonable when you came for your appointment?
Yes
No

If you had questions, did agency staff answer them?
Yes, always
Yes, sometimes
No
I didn't have any questions

Did you have confidence and trust in the staff that treated you/your loved one?
Yes, always
Yes, sometimes
No
If not, please explain 

Did you/your loved one feel like you were treated with courtesy, respect and dignity?
Yes, always
Yes, sometimes
No
If not, please explain 

Overall, how satisfied were you with the care you/your loved one received?
Very satisfied
Somewhat satisfied
Somewhat dissatisfied
Very dissatisfied
If not, please comment 

Would you recommend the services to your family and friends?
Yes, definitely
Yes, probably
No

Are you familiar with the Mental Health & Recovery Board of Portage County?
yes
no

How did you learn about the Mental Health & Recovery Board?
Newspaper
Internet Search
Word-of-mouth
Community Event
Other

Are you aware that the Board shares in the funding of the services you received?
Yes
No

Would you like to learn more about the MHRB?
Yes
No

Include your email to receive our newsletter 

Select your race/ethnicity
If other, please specify

Do you have further comments or impressions you would like to share?

13. If you would like a phone call or e-mail to discuss your care more thoroughly, please include your name and contact information below:

Name:
Daytime Phone Number: --
Best time to call:
Email:
Address:
City:
State:
Zip:

Thank you for completing this form. Your responses will be kept confidential.

If you have further concerns, questions or comments, please call the Associate Director at 330-673-1756, ext. 203, or click here to email.