Please indicate the answer to each of the follow questions that best represents
your opinion on the program you have been involved with during the past year.
Please provide information WITHOUT sharing your name.
Please provide information from YOUR perspective if you are the person receiving services.
If you are completing this survey on behalf of someone else, because he/she is unable to do so,
please provide HIS/HER input as appropriate.
This CONFIDENTIAL non-identifying information is very important to help ensure
that our services meet your needs.
USE THE SCROLL BAR AND YOUR MOUSE TO NAVIGATE THROUGHOUT THE SURVEY.
DO NOT USE "ENTER".
PRESS "SUBMIT" AT THE BOTTOM OF THE SURVEY TO PROCESS YOUR RESPONSES.
Thank you in advance for completing this survey.
~
LEWIS COUNTY COMMUNITY MENTAL HEALTH CENTER
7550 S. State Street, Lowville, NY 13367
Phone: 315-376-5450 ~ Fax: 315-376-7221 ~ Confidential Fax: 315-376-5501
http://www.lewismh.org/
lewismh@lewiscountyny.org
