Survey


Consumer Satisfaction Survey

Kindly drop off your completed survey to any DMHSA office or mail it to us at: DMHSA – HIPAA Privacy Officer 790 Governor Carlos Camacho Road Tamuning, Guam 96911.

Click here to download the pdf file for this Survey. 

Please click the button next to the answer of your choice. Once you are done with this survey, please click "Finished" at the bottom of the page.

1. Your Ethnicity:

Asian
American
Indian/Alaska Native
Black/African American
Caucasian(White Not Hispanic)
Chamorro
Chuukese
Filipino
Hispanic or Latino(All Races)
Kosraen
Marshallese
Palauan
Other


2. Sex:

Male
Female


3. Your Age:




4. Provider/Staff Name:




5. Outpatient:

Adult Counseling
Child/Adolescent
Case Management
Crisis Hotline
Day Treatment
Healing Hearts
I'Famagu-on'ta
Medication Clinic
New Beginnings


6. Inpatient:

Adult I
Adult II
Children's
Guma Ifil
Child/Adolescent Admin
Clinical Administration
Director's Office
Facility Operations
Medical Records
Nursing Admin
Peace
Personnel
Prevent


7. Please choose how well you think we are doing in the following areas:

Ease of getting care: (Note: Questions 7 to 10 are under this section.)


Ability to get in to be seen

Great
Good
Ok
Fair
Poor


8. Hours Department is Open

Great
Good
Ok
Fair
Poor


9. Convenience of Department location

Great
Good
Ok
Fair
Poor


10. Prompt return on calls

Great
Good
Ok
Fair
Poor


11. Waiting: (Note: Questions 11 to 14 are under this section)

Time in waiting room

Great
Good
Ok
Fair
Poor


12. Time in exam room

Great
Good
Ok
Fair
Poor


13. Waiting for tests to be performed

Great
Good
Ok
Fair
Poor


14. Waiting for test results

Great
Good
Ok
Fair
Poor


15. Staff:(Note: Questions 15 to 19 are under this section)

Provider:(Physician,Psychiatrist,Psyhologist,Counselor,Social Worker)

Listens to You:

Great
Good
Ok
Fair
Poor


16. Takes enough time with you:

Great
Good
Ok
Fair
Poor


17. Explains what you want to know

Great
Good
Ok
Fair
Poor


18. Gives you good advice and treatment

Great
Good
Ok
Fair
Poor


19. Nurses and Assistants : Psychiatric Technicians,Community Aides

Friendly and helpful to you

Great
Good
Ok
Fair
Poor


20. Facility (Note: Questions 20 to 23 are under this section)

Neat and clean building

Great
Good
Ok
Fair
Poor


21. Answers your questions

Great
Good
Ok
Fair
Poor


22. All Others

Friendly and helpful to you

Great
Good
Ok
Fair
Poor


23. Answers your questions

Great
Good
Ok
Fair
Poor


24. Ease of finding where to go

Great
Good
Ok
Fair
Poor


25. Comfort and safety while waiting

Great
Good
Ok
Fair
Poor


26. Privacy

Great
Good
Ok
Fair
Poor


27. Confidentiality:
Keeping my personal information private

Great
Good
Ok
Fair
Poor


28. The likelihood of referring your friends and relatives to us:

Great
Good
Ok
Fair
Poor


29. Do you consider this Department your regular source of care?

Yes
No


30. What do you like best about our services?




31. what do you like least about our services?




32. Suggestions for improvement?