Client Satisfaction Survey (in English)

It is important to us to find out how you feel about your services at the Montrose Center. If you will answer the questions below, it will help us improve our services. Both positive and negative comments about your experiences will be helpful. Please take a few minutes to complete this survey. Thanks for your help!

How long have you received services at the Center?

What is your age?

Why did you choose the Center for your services?

Which of the following services have you used? (check all that apply)

Please list the staff members you have worked with here:

Did you have any problems scheduling appointments?

Yes
No

If yes, please explain:

How would you rate the quality of services you have received?

4 Excellent
3 Good
2 Fair
1 Poor

Did you get the kind of services you wanted?

4 Yes, definitely
3 Yes, generally
2 No, not really
1 No, definitely not

If not, please explain:

To what extent has our program met your needs?

4 Almost all of my needs have been met
3 Most of my needs have been met
2 Only a few of my needs have been met
1 None of my needs have been met

If a friend were in need of some help, would you recommend our program to him or her?

4 Yes, definitely
3 Yes, I think so
2 No, I don’t think so
1 No, definitely not

Have the services you received helped you to deal more effectively with your problems?

4 Yes, they helped me a great deal
3 Yes, they helped somewhat
2 No, they really didn’t help
1 No, they seemed to make things worse

In an overall, general sense, how satisfied are you with the service you have received?

4 Very satisfied
3 Mostly satisfied
2 Indifferent or mildly dissatisfied
1 Quite dissatisfied

If you were to seek help again, would you come back to our program?

4 Yes, definitely
3 Yes, I think so
2 No, I don’t think so
1 No, definitely not

How involved do you feel you were in the development of your treatment or service plan?

4 Very much
3 Pretty much
2 Somewhat
1 Not at all

Do you feel physically safe at the Center?

4 Very much
3 Pretty much
2 Somewhat
1 Not at all

Did you have any problems with language, translations or interpretation of forms or services?

Very much (1)
Pretty much (2)
Somewhat (3)
Not at all (4)

Do you have any trouble getting to your appointments because of transportation?

4 Very much
3 Pretty much
2 Somewhat
1 Not at all

Do you feel your service providers understand and honor your culture?

4 Very much
3 Pretty much
2 Somewhat
1 Not at all

If there any services or groups that you think we should add, please list them here:

If there is anything we should change, please list it here:

The Montrose Center has a panel of consumers who meet on a regular basis to provide input and feedback about clinical and wellness needs and services. If you are interested in issues concerning the LGBTQIA and/or HIV+ communities of Houston and would like to be contacted regarding the panel, please provide your name and contact information. You will be contacted regarding application and participation in the panel.

If you like someone to contact you to follow-up on your comments, please give us your name and phone number here:

Sex at birth

Gender

Sexual Orientation

Ethnicity – Are you of Spanish/Latinx origin?

Race