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Momentum’s Outpatient Mental Health Clinic (OMHC)
Psychiatric Rehabilitative Program Adult & Minor (PRP)
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TRAINING
Home
About
Programs
Momentum’s Outpatient Mental Health Clinic (OMHC)
Psychiatric Rehabilitative Program Adult & Minor (PRP)
LGBTQ+ Division (PRP)
Substance Abuse Treatment
Client Info
Client instructions
Client Portal Login
Referral Form
Become a client today!
Resources
FAQ
Contact
Staff Portal
TRAINING
CLIENT SATISFACTION SURVEY
Step
1
of
2
50%
Date Survey Completed:
(Required)
MM slash DD slash YYYY
Client Name:
First
Last
Service Location:
(Required)
Programs:
(Required)
Mental Health
Medication Management
Psychiatric Rehabilitation
Contact Type:
(Required)
Phone/Video
In-Person
Not able to contact
To What Extent did the Counselor:
Help you achieve the purpose of which you sought services?
(Required)
Help you obtain skills that will help you handle future problems?
(Required)
Show interest in your needs?
(Required)
Educated you about aspects of your substance abuse/dependence/mental illness/wellness?
(Required)
Understands your needs?
(Required)
Involve you in the Treatment Planning Process? (such as treatment goals/appointments/etc)
(Required)
Respond to your requests for services and/or link you to additional services?
(Required)
How would you rate our intake process?
Are you willing to continue to services at BTST?
(Required)
Yes
No
Why?
Do you have any specific concerns about your treatment?
(Required)
Yes
No
Why?
Are there things you feel were especially good or helpful about your treatment?
(Required)
Yes
No
Why?
General Feedback:
