spacer spacer spacer spacer spacer spacer spacer

spacer
Connect With Us
SAMHSA Facebook SAMHSA Twitter SAMHSA YouTube SAMHSA Blog

2014 Toolkit


Customer Satisfaction Form

PDF Icon  Download the PDF version of "Customer Satisfaction Form" (164 KB).

We would like to know about your National Recovery Month (Recovery Month) efforts this September and how useful you found this toolkit for planning your activities. This information will be used in the development of future outreach materials distributed by the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT).

We would like to know about your efforts this September and how useful you found this toolkit for planning your activities. This information will be used in the development of future outreach materials distributed by SAMHSA, within the U.S. Department of Health and Human Services (HHS) (http://www.hhs.gov).

Your response is voluntary, but your input is essential so that the Recovery Month materials we provide in future years will continue to meet your needs. We encourage you to include photographs and/or samples of supporting materials from your Recovery Month activities.

* indicates a required field.






Example: xxx-xxx-xxxx






 
 
Did you receive media coverage?:
Did you receive media coverage?
 
 


Printed Materials Used It? How Useful Was It? Comments/Suggestions
Fast Facts About Health Reform, Substance Use and Mental Disorders, Treatment, and Recovery
Used fast facts?
How useful were fast facts?

Developing Your Social Network
Used developing your social network?
How useful was developing your social network?

Building Community Coalitions
Used was building community coalitions?
How useful was building community coalitions?

Planning Partners Directory
Used planning partners directory?
How useful was planning partners directory?

Single-State Agency Directory
Used Single-State Agency Directory?
How useful Single-State Agency Directory?

Prevention, Treatment, and Recovery Resources
Used Prevention, Treatment, and Recovery Resources?
How useful was Prevention, Treatment, and Recovery?

Targeted Outreach Booklet
Used targeted outreach booklet?
How useful was targeted outreach booklet?

Commonly Misused Substances Booklet
Used Commonly Misused Substances Booklet?
How useful was Commonly Misused Substances Booklet?

Join the Voices for Recovery Mini-Book
Used Voices Mini-Book?
How useful was Voices Mini-Book?



Online Materials Used It? How Useful Was It? Comments/Suggestions
Promoting Recovery Month With Events
Used promoting recovery month with events?
How useful was promoting recovery month with events?

Working With the Media
Used working with the media?
How useful was working with the media?

Press Materials for Your Recovery Month Event 
Used press materials?
How useful were press materials?

Writing an Op-ed During Recovery Month 
Used writing an op-ed?
How useful was writing an op-ed?

Official Recovery Month Proclamations
Used official proclamations?
How useful was official proclamations?

Using PSAs to Promote Recovery Month
Used using PSAs to promote recovery month?
How useful was using PSAs to promote recovery month?

Banners, Letterhead, and Logos
Used Banners, Letterhead, and Logos?
How useful was Banners, Letterhead, and Logos?

Overview: Recovery Benefits Everyone!
Used Overview: Recovery Benefits Everyone?
How useful was Recovery Benefits Everyone?

A Policymaker’s Guide for Combating Substance Use and Mental Disorders
Used policymaker's guide?
How useful was policymaker's guide?

Substance Use and Mental Disorders Affect All Individuals
Used Substance Use and Mental Disorders Affect All Individuals?
How useful was Substance Use and Mental Disorders Affect All Individuals?

Health Care Providers’ Role in Addressing Substance Use and Mental Disorders
Used Health Care Providers' Role?
How useful was Health Care Providers' Role?

Addressing Substance Use and Mental Disorders in the Workplace
Used Substance Use and Mental Disorders in the Workplace?
How useful was Substance Use and Mental Disorders in the Workplace?

Treatment and Recovery: Finding Personalized Help
Used treatment and recovery?
How useful was treatment and recovery?

Commonly Misused Substances
Used Commonly Misused Substances?
How useful was Commonly Misused Substances?

New Media Glossary
Used New Media Glossary?
How useful was New Media Glossary?

NOTE: Public reporting for this collection of information is estimated to average 10 minutes per response. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: SAMHSA Reports Clearance Officer, Paperwork Reduction Project (0930-0197); Room 5-1039, 1 Choke Cherry Road, Second Floor, Rockville, MD 20857. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 0930-0197 and the expiration date is 3/31/2014.




External link. Please review our Disclaimer