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.


Intersect Youth & Family Services Society is a non-profit community based agency in Prince George committed to the strengthening of individuals and families through support, education, outreach, counselling and advocacy. Intersect provides a variety of counselling services to children under the age of 19 and their families.



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

Important: Click the "I'm not a robot" checkbox above, before clicking the 'SEND' button.