Services Survey You recently requested support from Rockland Behavioral Health Response Team. Please help us improve our services by completing this brief survey. Thank you. Do you represent an agency or are you an individual who requested services from BHRT? I represent an agency, school, or other facility I am an individual not associated with an agency or organization What was the date you requested services?(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Was the service for you, a family member, friend, or someone else?(Required) Me Family Member Friend Colleague Other How quickly did we pick up the phone when you called?(Required) Within 1-2 rings Within 3-4 rings 4+ rings No one picked up, I left a message How quickly was it returned? Within 30 minutes Within an hour I did not get a call back If a team was sent to your location, how quickly did they arrive? Within 15 minutes Within 30 minutes Within an hour The BHRT representative responsive and caring?(Required) Strongly disagree Disagree Neutral Agree Strongly agree If the team came out to you, how would you rate their services when they arrived? 1= Poor 2 3 4 5 = Excellent Why did you rate them as you did in the previous question?Do you feel as though we helped you to resolve the circumstance that you were calling about?(Required) Yes No Not Sure Yet Would you recommend BHRT to someone else needing mental health support?(Required) Yes No Maybe Please provide the reason for your answer above.(Required)Would you reach out to us again in a similar scenario?(Required) Yes No Maybe How can we improve our services?If you would like us to follow up, please provide your name and contact information here. Thank you for helping us to improve our services.CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
