CHAC Community Listening Survey

1
Do you or your family/children attend (or have attended) CHAC’s clinical/therapy services?
Yes
No
2
Where? Select all that apply
Please Select
At School
At CHAC Clinic
3
What type of Clinic service did you access? Select all that apply
Please Select
Individual Therapy
Family Therapy
Couples Therapy
Group Therapy
Parenting Services
Assessment Clinic
4
Why did you choose CHAC Clinic services? Select all that apply
Please Select
Low Cost
Quick Response Time
Location
Bilingual Services
Familiarity with CHAC,
Recommendation/referral
Unique/specific service
Other
5
Why not?
Please Select
Please Select
Not Needed
Did not know about/understand CHAC Clinic services
Knew about CHAC but it did not offer what I needed
Was on waitlist for too long
Unsure of CHAC’s reputation
Went elsewhere
Other
6
Where else did you access services (instead of CHAC)? Check all that apply
Please Select
CHC
Gronowski Center
Private Therapist
County Behavioral Health
Medical Provider (HMO)
Other
N/A
7
What clinical/therapy services are most needed in the community?
Huge
Large
Normal
Small
Ok
Ok
Should be Empty: