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Local Planning & Network Development
Consumer and Family Survey

1. Please indicate which best describes your relationship with Helen Farabee Regional MHMR Centers.
I Receive Services at Helen Farabee Regional MHMR Centers
I have a Family Member or Friend who gets services at Helen Farabee Regional MHMR Centers
Member of NAMI
Member of ARC
 Other: Please Specify 

2. In which county do you live?

3. Are you aware that all Centers are now required by state law to explore contracting services they currently provide to interested third parties?
Yes    No

(If you answered No, and would like to receive additional information regarding changes that may affect the services you are receiving at the Center please contact the person listed at the end of this survey.) 

4. Please identify the three most important factors you consider when choosing a provider for services:

Convenient Location to home

 Pharmacy on site
 Transportation available Length of Appointment 
Clean Environment  Wait time to see the doctor
Cost of Services  Bilingual Services and Materials
Religious or Spiritual Values  Cultural/ Ethnic Sensitivity and Knowledge 
Reputation of Provider  All services at a single location
Other  

5. What service(s) would be most important for you to have a wider pool of providers to choose from?
Crisis Services Respite Services
Help to find and get a job  Doctor Services for MHMR
Counseling  Help to find and get a place to live
Learning the skills to take care of your self and live a better life

6. How important is a choice of providers to you?


PLEASE ANSWER THE FOLLOWING QUESTIONS ONLY IF YOU OR A FAMILY MEMBER RECEIVE SERVICES FROM
Helen Farabee Regional MHMR Centers
7. Which services you receive at Helen Farabee Regional MHMR Centers are most important and helpful to you?


8. Are there any services you would like that the center does not currently offer?


9. Are there any factors or obstacles that make it difficult for you to get services at Helen Farabee Regional MHMR Centers?


10. If you could, what service(s) are you interested in receiving from providers other than Helen Farabee Regional MHMR Centers?


11. On a scale of 1 to 5 how satisfied are you with the services you receive at Helen Farabee Regional MHMR Centers?

For more information please contact us at:
 Connie Johnston (940) 397-3370
johnstonc@helenfarabee.org
or visit our website at www.helenfarabee.org

THANK YOU FOR YOUR HELP WITH THIS SURVEY- YOUR OPINION COUNTS!