1.         Please indicate which best describes your relationship with Lakes Regional MHMR Center .  (Check only one box)

            I Receive Services at Lakes Regional MHMR Center

            I have a Family Member or Friend who gets services at Lakes Regional MHMR Center

            Member of NAMI                Member of ARC                 

            Interested Citizen               Center Staff                         

            Other: please specify:

2.         In which county do you live?  (Check only one box)

Hopkins     Lamar      Morris       Franklin

Delta          Titus         Camp

3.         Are you aware that all Centers are now required by state law to explore contracting services they currently provide to interested third parties? (Check only one box)

                          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 then please contact the person listed at the end of this survey. 

4.         On the list below, 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 and spiritual values     

Cultural/Ethnic Sensitivity & Knowledge

Reputation of Provider    All services at the same 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? (Check one)

         NOT IMPORTANT AT ALL

               NOT VERY IMPORTANT

               NO OPINION

               SOMEWHAT IMPORTANT

               VERY IMPORTANT

PLEASE ANSWER THE FOLLOWING QUESTIONS ONLY IF YOU OR A FAMILY MEMBER RECEIVE SERVICES FROM LAKES REGIONAL MHMR CENTER .

7.       Which of the services you receive at Lakes Regional  MHMR Center 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 Lakes Regional MHMR Center ?     

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

11.     On a scale of 1 to 5 how satisfied are you with the services you receive at Lakes Regional MHMR Center ?  (Check one)

             VERY UNSATISFIED        

             SOMEWHAT UNSATISFIED          

                 NEUTRAL         

                 SOMEWHAT SATISFIED       

                 VERY SATISFIED

Thank you for your participation with this survey for our Local Planning and Network Development efforts.  Please tell your family and friends to help us with this survey as well.  We will continue to have the survey available on our website through the month of May.  For more information about LPND, please contact Barbara Booth at the number below.

Lakes Regional MHMR Center

P. O. Box 747

Terrell , TX   75160

  barbarab@lrmhmrc.org

  972-524-4159 x 1148 phone

  972-388-2009 fax

THANK YOU FOR YOUR HELP WITH THIS SURVEY- 

YOUR OPINION COUNTS!