Integrated Wellness Provider Survey - Boris Lawrence Henson Foundation

Provider Name

First

Last

Provider Business Name

Email

How many groups have you serviced this quarter that were acquired through a BLHF program referral?

How many clients have you serviced this quarter that were acquired through a BLHF program referral?

How many clients have you worked with have found you through your BLHF Lets Talk! Resource Guide listing this quarter?

How satisfied were you with

	Very Unsatisfied	Unsatisfied	Neutral	Satisfied	Very Satisfied
Communication with BLHF staff	Very UnsatisfiedCommunication with BLHF staff Very Unsatisfied	UnsatisfiedCommunication with BLHF staff Unsatisfied	NeutralCommunication with BLHF staff Neutral	SatisfiedCommunication with BLHF staff Satisfied	Very SatisfiedCommunication with BLHF staff Very Satisfied
Notifications of upcoming programs, events and promotions	Very UnsatisfiedNotifications of upcoming programs, events and promotions Very Unsatisfied	UnsatisfiedNotifications of upcoming programs, events and promotions Unsatisfied	NeutralNotifications of upcoming programs, events and promotions Neutral	SatisfiedNotifications of upcoming programs, events and promotions Satisfied	Very SatisfiedNotifications of upcoming programs, events and promotions Very Satisfied
Invoicing for services rendered	Very UnsatisfiedInvoicing for services rendered Very Unsatisfied	UnsatisfiedInvoicing for services rendered Unsatisfied	NeutralInvoicing for services rendered Neutral	SatisfiedInvoicing for services rendered Satisfied	Very SatisfiedInvoicing for services rendered Very Satisfied
Number of clients referred	Very UnsatisfiedNumber of clients referred Very Unsatisfied	UnsatisfiedNumber of clients referred Unsatisfied	NeutralNumber of clients referred Neutral	SatisfiedNumber of clients referred Satisfied	Very SatisfiedNumber of clients referred Very Satisfied
Navigating the BLHF Let's Talk! Resource Guide webpage	Very UnsatisfiedNavigating the BLHF Let's Talk! Resource Guide webpage Very Unsatisfied	UnsatisfiedNavigating the BLHF Let's Talk! Resource Guide webpage Unsatisfied	NeutralNavigating the BLHF Let's Talk! Resource Guide webpage Neutral	SatisfiedNavigating the BLHF Let's Talk! Resource Guide webpage Satisfied	Very SatisfiedNavigating the BLHF Let's Talk! Resource Guide webpage Very Satisfied
Information from BLHF about upcoming initiatives, programs and events	Very UnsatisfiedInformation from BLHF about upcoming initiatives, programs and events Very Unsatisfied	UnsatisfiedInformation from BLHF about upcoming initiatives, programs and events Unsatisfied	NeutralInformation from BLHF about upcoming initiatives, programs and events Neutral	SatisfiedInformation from BLHF about upcoming initiatives, programs and events Satisfied	Very SatisfiedInformation from BLHF about upcoming initiatives, programs and events Very Satisfied

Please identify whether you have engaged with any of the following BLHF activities and for each you have engaged with

Resource Guide Ambassadors Program
Quarterly Meet-Up
Cultural Humility Training
Integrated Wellness Event

Please identify your level of satisfaction with the Resource Guide Ambassadors Program

Very Unsatisfied	Unsatisfied	Neutral	Satisfied	Very Satisfied
Very UnsatisfiedItem #1 Very Unsatisfied	UnsatisfiedItem #1 Unsatisfied	NeutralItem #1 Neutral	SatisfiedItem #1 Satisfied	Very SatisfiedItem #1 Very Satisfied

Please identify your level of satisfaction with the Quarterly Meet-Up

Very Unsatisfied	Unsatisfied	Neutral	Satisfied	Very Satisfied
Very UnsatisfiedItem #1 Very Unsatisfied	UnsatisfiedItem #1 Unsatisfied	NeutralItem #1 Neutral	SatisfiedItem #1 Satisfied	Very SatisfiedItem #1 Very Satisfied

Please identify your level of satisfaction with the Cultural Humility Training

Very Unsatisfied	Unsatisfied	Neutral	Satisfied	Very Satisfied
Very UnsatisfiedItem #1 Very Unsatisfied	UnsatisfiedItem #1 Unsatisfied	NeutralItem #1 Neutral	SatisfiedItem #1 Satisfied	Very SatisfiedItem #1 Very Satisfied

Please identify your level of satisfaction with the Integrated Wellness Event

Very Unsatisfied	Unsatisfied	Neutral	Satisfied	Very Satisfied
Very UnsatisfiedItem #1 Very Unsatisfied	UnsatisfiedItem #1 Unsatisfied	NeutralItem #1 Neutral	SatisfiedItem #1 Satisfied	Very SatisfiedItem #1 Very Satisfied

How likely are you to

	Unlikely	Neutral	Likely
Continue working as a mental health provider in partnership with the BLHF	UnlikelyContinue working as a mental health provider in partnership with the BLHF Unlikely	NeutralContinue working as a mental health provider in partnership with the BLHF Neutral	LikelyContinue working as a mental health provider in partnership with the BLHF Likely
Encourage other clinicians to join the BLHF Let’s Talk Resource Guide	UnlikelyEncourage other clinicians to join the BLHF Let’s Talk Resource Guide Unlikely	NeutralEncourage other clinicians to join the BLHF Let’s Talk Resource Guide Neutral	LikelyEncourage other clinicians to join the BLHF Let’s Talk Resource Guide Likely
Recommend BLHF services to potential clients	UnlikelyRecommend BLHF services to potential clients Unlikely	NeutralRecommend BLHF services to potential clients Neutral	LikelyRecommend BLHF services to potential clients Likely

Overall, how would you rate your experience with the BLHF?

Please share details about your overall experience with the BLHF. If you have any suggestions for improvement, we encourage you to please share them

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