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LCSC Customer Service Kiosk
Hi there, please take a moment to complete a brief survey, register a suggestion or complaint, or let us know if your information has changed.
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1
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Satisfaction Survey
Suggestion
Complaint
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2
Suggestion
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please let us know if you have any suggestions for LCSC
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please register your complaint below
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Change of Information
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please input your Name and Telephone number and then list any changed information
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5
I am a:
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please select one
Person receiving services
Parent or family member
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6
Approximately when did you/your child begin services?
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Date
Month
Day
Year
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7
When I/my child started services at LCSC, I would rate my symptoms as:
1
2
3
4
5
6
7
8
9
10
MILD
SEVERE
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8
Today, I would rate my/my child's symptoms as:
1
2
3
4
5
6
7
8
9
10
MILD
SEVERE
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9
It is easy to make convenient appointments in person or remotely if needed:
All of the time
Most of the time
Some of the time
Rarely
Never
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10
The LCSC staff treat me/my child with respect:
All of the time
Most of the time
Some of the time
Rarely
Never
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11
The environment at LCSC is welcoming:
All of the time
Most of the time
Some of the time
Rarely
Never
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12
LCSC staff encourage me/my child to participate in my recovery plan and treatment:
All of the time
Most of the time
Some of the time
Rarely
Never
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13
LCSC staff give me/my child referrals and follows up with referrals when needed:
All of the time
Most of the time
Some of the time
Rarely
Never
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14
LCSC staff helps me/my child have hope for the future:
All of the time
Most of the time
Some of the time
Rarely
Never
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15
Do you/your child receive more than one service from LCSC
e.g. dietician, mentor, neuropsych evaluation,, meals, etc.
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NO
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16
How satisfied are you with the multiple services that you/your child receive from LCSC?
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5
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9
10
LESS SATISFIED
VERY SATISFIED
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Comment:
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18
Name (OPTIONAL)
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First Name
Last Name
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