Barton County PMI Client Satisfaction Survey

0.08 MB·English

1M Kansan venus, Sas B
‘Great Bend, Karas 67590

Boston Invests tn Growth

WALT DEPARTMENT

County

(aug) a9

Prognancy Ralntenance Initiative
‘Client Satisfaction Survey

1. Agency Name:
2. Agency ity

3. How did you tear about these services:
Friend/Relative
Pregnancy Care Provider
‘Media (¥, radio, newspaper)
Sacial Media (Facebook, Tithe, ce)
‘Adoption Agency
Haspitat

Brochure ram ageney sted above
arch

Heatth Department

Another agency:

School _

ther, specie

AL heckthe services that you received a¢ a result of your participation with the Teen Pregnaney TCM

Prenatal Mesteal Core

Medical Care [nom-pregnaicy related
cient Infant

Housing/Utites

Alternative fducatton

Paternal lnvalvement Support

tess than 1 weak
week
2ewceks

‘Adoption Guidance
Drug¢Alcohol AssessmenlyTreatment
Domestic Abuse Protection

hls care

Parenting Ceucston Support
Transpertation

Howe long ald you wait for your first visit with the Teen Pregnancy TCM cage manager?

aeeks
Awasks ormore

6. Did youhave problems getting tothe services (e.g. t2nsportations, appoliatments conflicted with work
schedule of school child care}? NoYes Describu the probe

1. Wiere the daysand times far services good for ou? No Yes Describe the problem:

8. Onthe average, how long did you have to wt befare you wera seen bythe case manager or other staff at
thisageney: less than 15min
50min,
31-45
10.

a

as,

Durlog your visits:

Did the case manager carefull Isten to you? Yes Na
ld service prouiders carefully listen to yuu? es no
De you feel you sriigated in the goal planring? Yes No
‘were things explained ina sway you could wnderscand? Yes no

Ifyou checked “NO” Lo any af the above, plesse explain:

Did you feel you were fully informed of

Available servees te camtinue your pregnancy? Yes No
oration of serces? Yer No
Requirements of services? Yes No
Length of services during pregnancy and after? Yes No

I these services had been unavailable, what would! you have done In relation ta your pregnancy & other
reeds? —

2. Would you recommend these services to aftlend orvelative? Yes No
2
1 What is your race? White/Caucasian Black/African Amvican American Indian/Alaskan Matve

How old areyou? ____years.

Asian Native Hawailan/Pactfic dander Other

Do youconsideryourseltto be af Hispanic origin? Yet No