Path to Recovery: Client Experience Survey

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for participating in this confidential survey. Your responses will help us improve our services and meet reporting requirements for our grant funding. This survey is anonymous and will take about 5 minutes to complete. Your honest feedback is greatly appreciated.
Instructions:
Please answer all questions to the best of your ability.
For multiple-choice questions, select the most appropriate answer.
For rating scales, circle the number that best represents your experience.

Section 1: Emergency Services and Hospitalizations

Date

YYYY

In the past 3 months, have you used emergency services (crisis hotline, ER visit)for behavioral health reasons?

Yes

If yes , How many times ?

In the past 3 months, have you been hospitalized for behavioral health reasons?

Yes

Clear selection

If yes , How many times ?

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms