How satisfied are you with each of the following items?
Very Satisfied
Somewhat Satisfied
Somewhat Not Satisfied
Not Satisfied
The Services in General
The referral process
Relationship with the Primary Counselor
Relationship with the Mental Health Liaison
Your involvement with treatment planning
Response by staff to questions
Response by staff to phone calls
Length of the treatment program
Accuracy of appointments scheduling
Access to Therapist
Time of Sessions
Cost of Service
Other
What would make this experience more helpful? What would need to be different?
What could be done to make Mid-Ohio Psychological Services a better place to receive services?
Demographics
Please provide the following demographic information. It will only be used to make statistical comparisons between different groups of respondents; it will not be used to profile individual respondents. What is your gender?
Male
Female
How old are you?
20 - 29
30 - 39
40 - 49
50 - 59
60+
Which of the following best represents the highest level of education that you have completed?
Some high school or less
High school graduate
Attended some college
Associates degree
Bachelors degree
Post-college graduate
What is your marital status?
Married/Life Partner
Not married
What are the age ranges of any children 18 years of age or younger living in your household? Choose all that apply.
Under Age 6 years
Aged 6-12
Aged 13-18
Have no children 18 or under living in household
With which of the following groups do you most identify?
African-American/Black
Asian-American or Pacific Islander
Hispanic/Latino
Native American
White
Other
Which of the following best describes your income in the past 12 months?