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Your Feedback is Important. Tell Us How We're Doing!
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Adult Client Survey:
The Indiana Division of Mental Health and Addiction would like you to fill out a short survey about the services you receive from us. The State wants to make sure that mental health and addiction centers give high-quality care.
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This survey will help the State understand what you think about these services. Filling out the survey is your choice. If you decide not to, that is okay, no one will ask you why.
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The survey will not ask for your name unless you choose to share it. At the end of the survey, you can write comments about the services you receive. If you want your provider to follow up regarding your comments, you can include your name.
Your feedback will help improve mental health and addiction services in Indiana.
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Please complete the survey before you leave today. Place it in the confidential box or envelope provided. We will send the completed surveys to the State.
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Use the pencil provided. Fill in each circle completely so there are no white spots. Do not use X’s or check marks. Only choose one circle per question.
Thank you for your time and honest feedback.
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Survey for ADULTS Receiving Services from Southwestern Behavioral Healthcare
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Youth Client Survey:
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The Indiana Division of Mental Health and Addiction would like you to fill out a short survey about the services your child receives from us. The State wants to make sure that mental health and addiction centers provide high-quality care.
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This survey will help the State understand what you think about your child’s services. Completing the survey is your choice. If you choose not to, that is okay, no one will ask why. If more than one of your children receives services, please fill out a separate survey for each child.
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The survey will not ask for your name unless you choose to share it. At the end of the survey, you can write comments about the services your child receives. If you want your child’s provider to follow up regarding your comments, you can include your name.
Your feedback will help improve mental health and addiction services in Indiana.
​
Please complete the survey before you leave today. Place it in the confidential box or envelope provided. We will send the completed surveys to the State.
​
Use the pencil provided. Fill in each circle completely so there are no white spots. Do not use X’s or check marks. Only choose one circle per question.
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Thank you for your time and honest feedback.
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Survey for PARENTS/GUARDIANS of a Child Receiving Services from Southwestern Behavioral Healthcare
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