Your Voice Matters: Client Feedback, Concerns & Grievances

We are committed to providing services that are respectful, accessible, culturally responsive, and trauma-informed.

You have the right to express concerns, file a grievance, or share suggestions about your care without fear of retaliation. Your feedback helps us improve the quality, safety, and effectiveness of our services. Your feedback is confidential and helps us improve the quality, safety, and effectiveness of our services. Thank you for taking the time to share your experience.

1. What type of feedback are you submitting today?

Suggestion
Concern
Compliant
Formal Grievance
Compliment

2. How would you rate your overall experience with our facility?

Excellent
Good
Fair
Poor

3. Did you feel treated with dignity, respect and cultural sensitivity?

Yes
Somewhat
No

4. Did staff communicate with you in a clear, supportive, and understandable way?

Yes
Somewhat
No

5. Do you feel your mental health needs and concerns were taken seriously?

Yes
Somewhat
No

6. Did you feel emotionally and physically safe while receiving services?

Yes
Somewhat
No

7. If you are reporting a concern or grievance, please describe what happened in your own words.

8. Do you feel that your rights as a client were respected?

Yes
Unsure
No

in respect seriously?

9. What changes or improvements would you like us to consider?

10. Would you like someone from our leadership or compliance team to follow up with you?

Yes, please provide contact information below
No, I prefer not to be contacted
Third Choice

Only if you answered "yes" to question 10 please add name and contact information.

First

Last

Phone