155 East Main St., Kent, Ohio 44240

Customer Satisfaction Survey

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 received services?
 Me Loved One Other

Which Mental Health & Recovery Board agency provided the services?

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 explain:

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?

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

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Select your race/ethnicity:

If other, please specify:

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

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

First Name:   

Last Name:   

Daytime Phone Number:   

Best Time to Call:   


Street Address:   


State / Province:   

ZIP / Postal Code:   

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