Intake Experience Survey

We have recently made some improvements to the CYMH Intake service. Your experience is important to us and we hope you will take a few moments to provide your thoughts in this anonymous questionnaire. Information will be kept strictly confidential and no personal information will be shared in any reports.

Please fill out all information.

 

Accessing the Intake Service

 

Not at all   To some extent   To a great extent
Not at all   To some extent   To a great extent
Not at all   To some extent   To a great extent
Not at all   To some extent   To a great extent

Not at all   To some extent   To a great extent

 

Your Experience in the Waiting Room

minutes
  Yes   No
  Yes   No

 

Your Experience with the Intake Clinician

  Yes   No
  To a great extent   Somewhat   Very little   Not at all
  To a great extent   Somewhat   Very little   Not at all

 

Your Overall Experience

  Very satisfied   Satisfied   Neutral   Dissatisfied   Very dissatisfied

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