Prince George County Mental Wellness Client Survey

Name *

First

Last

Client ID *

This is NOT your SSN. Refer to the registration sign-up email for your client number, please use the full ID numbers and letters.

Email Address *

Your Therapist / Mental Health Provider *

Please use the drop-down menu to choose your Provider.

Session Date / Time *

Date

Time

How satisfied were you with *

	Unsatisfied	Neutral	Very Satisfied
Your Treatment	Your Treatment Unsatisfied	Your Treatment Neutral	Your Treatment Very Satisfied
Timely Session Scheduling	Timely Session Scheduling Unsatisfied	Timely Session Scheduling Neutral	Timely Session Scheduling Very Satisfied
Technology	Technology Unsatisfied	Technology Neutral	Technology Very Satisfied

How likely are you to *

	Unlikely	Neutral	Likely
Schedule a new appointment	Schedule a new appointment Unlikely	Schedule a new appointment Neutral	Schedule a new appointment Likely
Recommend this provider to others	Recommend this provider to others Unlikely	Recommend this provider to others Neutral	Recommend this provider to others Likely
Recommend BLHF to others	Recommend BLHF to others Unlikely	Recommend BLHF to others Neutral	Recommend BLHF to others Likely

Have you scheduled a follow-up visit with this provider? *

How was your experience? *

We're sorry you if did not have a good experience. Please let us know how we can do better.

Name

Facebook Watch has renewed the Daytime Emmy-nominated Peace of Mind with Taraji, hosted by Golden Globe Award-Winning Actress Taraji P. Henson and her best friend and co-host Tracie Jade, the Executive Director of the Boris Lawrence Henson Foundation, for a second season.

Peace of Mind with Taraji shines a spotlight on the challenging mental health issues facing us today - especially those in the Black community. Through personal interviews with celebrities, experts, and everyday people, the series shows how to provide support, bring awareness, and aims to destigmatize mental health issues.

Check out @tarajiphenson or @traciejade Facebook page to watch the show.

"We’ve long been mental health advocates for the Black community and founded BLHF to educate and provide resources to those who are struggling with talking about their challenges. In season two of Peace of Mind, we will continue to open the door for impactful and relevant conversations. Partnering with Facebook allows us to engage more broadly with our community, sharing our own personal battles with mental health as well, in hopes that they see themselves in us. The more we talk about it, the more comfortable others will feel talking about it." as shared by Taraji and Tracie

We will talk, we will laugh, we will cry…., we gon’ heal, TOGETHER!

Check out @tarajiphenson or @traciejade Facebook page to watch the show.

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