MHICM Consumer Satisfaction Survey

MHICM CONSUMER QUESTIONNAIRE

OMB No. 2900-0770
Estimated Burden: 10 minutes

Expiration Date: 08/31/2017

The Paperwork Reduction Act of 1995: This information is collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Accordingly, we may not conduct or sponsor and you are not required to respond to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who complete this survey will average 10 minutes. This includes the time it will take to follow instructions, gather the necessary facts and respond to questions asked. Customer satisfaction is used to gauge customer perceptions of VA services as well as customer expectations and desires. The results of this telephone/mail survey will lead to improvements in the quality of service delivery by helping to achieve services. Participation in this survey is voluntary and failure to respond will have no impact on benefits to which you may be entitled.

MHICM CONSUMER QUESTIONNAIRE
Questions	Response	Response	Response	Response	Response
1. I am satisfied with the mental health services I receive from MHICM staff.	Strongly Agree	Agree	No Opinion	Disagree	Strongly Disagree
2. Staff and residents are sensitive to my cultural needs.	Strongly Agree	Agree	No Opinion	Disagree	Strongly Disagree
3. I am learning about my medications, their side effects, and how to take them by myself.	Strongly Agree	Agree	No Opinion	Disagree	Strongly Disagree
4. My case manager involves me in decisions about my care based on my needs, abilities, Preferences.	Strongly Agree	Agree	No Opinion	Disagree	Strongly Disagree
5. People here encourage me to grow, change and strive towards recovery and healthy life habits.	Strongly Agree	Agree	No Opinion	Disagree	Strongly Disagree
6. Most of the groups I attend are beneficial for my treatment goals.	Strongly Agree	Agree	No Opinion	Disagree	Strongly Disagree
7. My case manager assesses my safety by use of suicide risk assessment with each visit and/or my safety crisis management plan.	Strongly Agree	Agree	No Opinion	Disagree	Strongly Disagree
8. I am better able to handle things when they go wrong.	Strongly Agree	Agree	No Opinion	Disagree	Strongly Disagree
9. I am better able to do things I want to do.	Strongly Agree	Agree	No Opinion	Disagree	Strongly Disagree
10. I got the services I needed.	Strongly Agree	Agree	No Opinion	Disagree	Strongly Disagree
12. I felt like a valued customer.	Strongly Agree	Agree	No Opinion	Disagree	Strongly Disagree
13. I trust the VA to fulfil our country’s commitment to Veterans.	Strongly Agree	Agree	No Opinion	Disagree	Strongly Disagree

Use this space for any concerns, feedback, or improvements MHICM could make. Thank you!