Satisfaction Survey (in English) It is important to us to find out how you feel about your services at the Montrose Center. If you will answer the questions below, it will help us improve our services. Both positive and negative comments about your experiences will be helpful. Please take a few minutes to complete this survey and return it to the box in the lobby. Thanks for your help! How long have you received services at the Center? What is your age? Why did you choose the Center for your services?Which of the following services have you used? (check all that apply)Individual CounselingCouples/Family CounselingGroup CounselingIntensive OutpatientCase ManagementRecovery CoachingOtherIndividual or Couples Counselor's Name: Group Counselor's Name: Case Manager's Name: Recovery Coach's Name: Please explain other services and providers here: Did you have any problems scheduling an intake or your first session? Yes No If yes, please explain: How would you rate the quality of services you have received? 4 Excellent 3 Good 2 Fair 1 Poor Did you get the kind of services you wanted? 1 No, definitely not 2 No, not really 3 Yes, generally 4 Yes, definitely To what extent has our program met your needs? 4 Almost all of my needs have been met 3 Most of my needs have been met 2 Only a few of my needs have been met 1 None of my needs have been met If a friend were in need of some help, would you recommend our program to him or her? 1 No, definitely not 2 No, I don’t think so 3 Yes, I think so 4 Yes, definitely How satisfied are you with the amount of help you have received? 1 Quite dissatisfied 2 Indifferent or mildly dissatisfied 3 Mostly satisfied 4 Very satisfied Have the services you received helped you to deal more effectively with your problems? 4 Yes, they helped me a great deal 3 Yes, they helped somewhat 2 No, they really didn’t help 1 No, they seemed to make things worse In an overall, general sense, how satisfied are you with the service you have received? 4 Very satisfied 3 Mostly satisfied 2 Indifferent or mildly dissatisfied 1 Quite dissatisfied If you were to seek help again, would you come back to our program? 1 No, definitely not 2 No, I don’t think so 3 Yes, I think so 4 Yes, definitely How involved do you feel you were in the development of your treatment or service plan? 1 Not at all 2 Somewhat 3 Pretty much 4 Very much Do you feel physically safe at the Center? 1 Not at all 2 Somewhat 3 Pretty much 4 Very much Did you have any problems with language, translations or interpretation of forms or services? 1 Not at all 2 Somewhat 3 Pretty much 4 Very much Do you have any trouble getting to your appointments because of transportation? 1 Not at all 2 Somewhat 3 Pretty much 4 Very much Do you feel your service providers understand and honor your culture? 1 Not at all 2 Somewhat 3 Pretty much 4 Very much Tell us your story. What were you experiencing that made you call the Center? How did we help you?If there any services or groups that you think we should add, please list them here:If there anything we should change, please detail it here:The Montrose Center has a panel of consumers who meet on a regular basis to provide input and feedback about clinical and wellness needs and services. If you are interested in issues concerning the LGBTQIA and/or HIV+ communities of Houston and would like to be contacted regarding the panel, please provide your name and contact information. You will be contacted regarding application and participation in the panel. Or, if you like someone to contact you to follow-up on your comments, please give us your name and phone number here: Sex at birthMaleFemaleIntersexGendercis-Malecis-FemaleTransgender Female/FeminineTransgender Male/MasculineGenderqueerPangenderDecline to AnswerSexual OrientationAsexualBisexualGayGay/LesbianHeterosexual/StraightLesbianPansexual QueerQuestioningDon’t KnowOtherDecline to AnswerEthnicity - Are you of Spanish/Latinx origin?YesNoDecline to AnswerRaceAmerican Indian or Alaska NativeAsianBlack/African AmericanNative Hawaiian/PIWhiteOtherDecline to Answer
