Language
English (US)
العربية
Русский
Community Behavioral Health Center (CBHC)2026–2027 CLIENT SATISFACTION SURVEY
Thank you for taking a few minutes to share your experience with us. Your feedback helps CBHC improve the quality, safety, and respectfulness of the care we provide throughout Ohio.
This survey is voluntary and confidential. Your answers will not affect the services you receive, and only summarized results are shared with staff and leadership for quality improvement.
You may leave any question blank. If a question does not apply to you, mark N/A.
Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
1. Services I Receive at CBHC (check all that apply)
Services I Receive at CBHC (check all that apply)
Psychiatry / Medication Mgmt.
Therapy / Counseling
Case Management
For questions 2–6 below, please circle or check one box per statement:
5 = Strongly Agree 4 = Agree 3 = Neutral 2 = Disagree 1 = Strongly Disagree N/A = Not Applicable
2. Scheduling & Access
2. Scheduling & Access
Rows
5 SA
4 A
3 N
2D
1 SD
N/A
I am able to get an appointment when I need one.
I am satisfied with the CBHC appointment reminder system.
It is easy to access services by telehealth and/or by phone.
I am able to reach my care team when I need help between scheduled appointments.
3. Treatment & Care Planning
3. Treatment & Care Planning
Rows
5 SA
4A
3 N
2D
1 SD
N/A
It is easy to talk about my mental health with providers who really listen to me.
There is good communication among CBHC staff regarding my treatment.
I was actively involved in developing my treatment plan and setting my goals.
I understand my treatment goals.
I understand the role of medication in my treatment (if applicable).
Back
Next
Rows
5 SA
4 A
3 N
2D
1 SD
N/A
I am confident I am receiving the right treatment for my condition.
The condition for which I am being treated has improved.
4. Rights, Safety & Respect
4. Rights, Safety & Respect
Rows
5 SA
4A
3N
2D
1 SD
N/A
I am treated with dignity and respect by CBHC staff.
My cultural, spiritual, and personal values and beliefs are respected.
I feel physically and emotionally safe when receiving services at CBHC.
I was informed of my rights and responsibilities as a client.
Staff talked with me about safety planning and crisis resources, if needed.
5. Communication & Problem Resolution
5. Communication & Problem Resolution
Rows
5 SA
4A
3 N
2D
1 SD
N/A
I know how to reach CBHC in a crisis or after regular business hours.
I know how to share a concern, complaint, or grievance if I have one.
When I raised a concern, it was addressed to my satisfaction.
6. Overall Satisfaction
6. Overall Satisfaction
Rows
5 SA
4A
3N
2D
1 SD
N/A
Overall, I am satisfied with the treatment I received at CBHC.
The services I received have helped me make progress toward my goals.
I would recommend CBHC to a friend or family member.
7. Tell Us More
What is CBHC doing well?
Back
Next
What could CBHC do better?
Any additional comments?
8. About You (Optional)
These questions are optional and help us understand whether all clients are receiving equally respectful, high-quality care. You may skip any question.
Age
Under 18
18–25
26–40
41–64
65+
Gender
Gender: M
Gender: F
Prefer not to answer
Race/ethnicity
Prefer not to answer
Race/ethnicity:
Primary language:
Interpreter needed?
Yes
No
9. Follow-Up (Optional)
This survey is anonymous unless you choose to give us your contact information below. If you'd like a staff member to follow up with you about your feedback, please provide:
Name:
First Name
Last Name
Phone/Email:
Thank you for helping us improve. Please return this survey to the front desk, place it in the confidential drop box in the waiting area, or email it to: info@cbhcweb.com
If you have an urgent safety concern or are in crisis, please contact your care team, call/text 988 (Suicide & Crisis Lifeline), or call 911.
Preview PDF
Submit
Should be Empty: