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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.

Please fill out all information.

Date: (mm/dd/yyyy)

Accessing the Intake Service

1. How did you hear about this intake service?

2. To what extent did any of the following make it difficult to access this intake service?

Location: Not at all To some extent To a great extent

Intake service hours: Not at all To some extent To a great extent

Transportation: Not at all To some extent To a great extent

Lack of child care: Not at all To some extent To a great extent

Other:

Not at all To some extent To a great extent

Your Experience in the Waiting Room

3. Approximately how long were you waiting in the waiting room to be seen by a clinician today?:

minutes

Do you feel this was a reasonable length of time to be waiting?:

Yes No

4. Did you feel you were treated in a respectful manner by staff at the intake service today?:

Yes No

Your Experience with the Intake Clinician

5. Were the next steps for you and/or your child communicated clearly to you by the clinician today?:

Yes No

6. To what extent did you feel today's visit to the intake service met the needs of you and your family?:

To a great extent Somewhat Very little Not at all

7. To what extent did you feel heard by the clinician today?:

To a great extent Somewhat Very little Not at all

Your Overall Experience

8. Overall, how satisfied are you with your experience at the intake service today?:

Very satisfied Satisfied Neutral Dissatisfied Very dissatisfied

9. Do you have any further feedback?

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

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.

Your donations have a direct impact on the youth, children and families of northern BC. Find out More.

© 2019 Intersect Youth & Family Services Privacy | Terms
p: 250.562.6639 | f: 250.562.4692
1294 3rd Avenue Prince George, BC Canada V2L 3E6

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