Greene ESC Mental Health Services Stakeholder Feedback Form
Sign in to Google to save your progress. Learn more
Your Name *
Your Title *
Therapist *
District/Program *
Date *
MM
/
DD
/
YYYY
Overall satisfaction with mental health services provided by the Greene County ESC
not satisfied
satisfied
Clear selection
Responds in a timely manner (Rating) *
not satisfied
satisfied
Responds in a timely manner (Comments)
Available for crisis intervention (Rating) *
not satisfied
satisfied
Available for crisis intervention (Comments)
Consistently follows-up with school staff (Rating) *
not satisfied
satisfied
Consistently to follows-up with school staff (Comments)
Prompt (attending district meetings such as IEP or staff meetings if applicable) (Rating) *
not satisfied
satisfied
Prompt (attending district meetings such as IEP or staff meetings if applicable) (Comments)
Reliable (Rating) *
not satisfied
satisfied
Reliable (Comments)
Flexible (Rating) *
not satisfied
satisfied
Flexible (Comments)
Presents in a professional manner (Rating) *
not satisfied
satisfied
Professional manner (Comments)
Provides helpful support to students (Rating) *
not satisfied
satisfied
Provides helpful support to students (Comments)
Provides helpful support to staff (Rating) *
not satisfied
satisfied
Provides helpful support to staff (Comments)
Aspects of Mental Health services you find most valuable to your school/district *
Any additional comments:
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy