The following survey is an opportunity for you to give DWIHN feedback regarding your satisfaction with CLS services and/or staff. Please note that this survey should be completed by the member receiving the service or the parent/guardian of the member receiving the service as appropriate. Your CMH Therapist, Facilitator, Supports Coordinator or Case Manager can assist you as needed. This survey should not be completed by a CLS staff person or with their help/input. This survey should be completed every 6 months while receiving CLS services. This survey and any information transmitted within it are confidential and intended solely for the use of the individual or entity to whom they are addressed. This survey contains confidential information and is intended only for the intended individual. If you are not the intended individual you should not disseminate, distribute, or copy this survey or its contents.

In regard to children and youth receiving CLS, If you have any questions or concerns please contact Kim Hoga @ khoga1@dwihn.org, or Monica Hampton at mhampton@dwihn.org.

In regard to adults receiving CLS, if you have any questions or concerns please contact Marianne Lyons at mlyons@dwihn.org.