Family Member Questionnaire


(For a Spanish language version of this questionnaire, please click here.)

CST would like to know what you, as a family member, think of the behavioral health services that your loved one is receiving. Please take just a few minutes to fill out and return this form to us.

1. What types of services does your family member receive? Adult Mental Health Substance Abuse Child/Adolescent Behavioral Health Services Dual/Co-Occurring (MH/SA) 2. What is the name of the agency that provides your family member's services? 3. Have you been contacted by your loved one's behavior health service provider? If so, why? 4. Have you been included in your family member's treatment process? If so, how and who encourages this inclusion? (CM, friend, family member, support group) 5. Do you need any support services and/or resources to help you better understand your loved one's recovery process? If so, what do you think you need? 6. Do you feel that your family member's physical health care needs are being met? If you know who is paying for your family member's treatment or living arangements, please let us know (CBH, OMH, BHSI, Private Insurance, etc.): Optional: If you want CST to contact you, please fill out this information: Name: Address: Phone: Please enter the security code that appears below: