Four County Mental Health Center, Inc.  Serving Chautauqua, Elk, Montgomery and Wilson County, Kansas

 "Four County Mental Health Center  is dedicated to providing  accessible, innovative services in partnership with individuals, families and our communities."

 

Four County Mental Health Center
Prevention and Outreach
 Feedback Form

The Prevention and Outreach Department is asking for your feedback in regard to the various activities, events, and media outreach that we provide at Four County. We welcome your comments and suggestions on things that you see happening at Four County in the way of public outreach.  Please let us know what you have seen that you like, what ideas you have that might be a positive outreach to our patients and communities.  If you have suggestions as to how to change our outreach, media, web, radio, etc. please comment on that.  It is always helpful to have input as you perceive our efforts or maybe have heard comments from your patients.  The information we receive will assist us in planning future Prevention and Outreach activities. 

WEB SITE

What do you like about the overall look of the web site? 

How many times weekly do you access the web site? 

What aspects of the web site are helpful in your work?

What features would make the web site easier for you to navigate?

What other features would you like to see included on the web site? 

What would make this site more appealing to prospective employees?

What would make this site more appealing to potential business/community partners?

What would make this site helpful for patients?

PRINTED MATERIALS - (Business Cards, Brochures, etc.) 

Where do you distribute your business cards: 
Community partners
 Patients
 Staff
 Other

Do you use our brochures in your community outreach? Yes No

 How?

MEDIA

How have you seen or heard information about Four County?
 Newspaper
 Television
Radio

Is the information that you have seen or heard understandable?  Yes No

Newspaper Articles Comments:

Television Ads Comments:

Radio Ads Comments:

Reflections TV Program Comments: 

Other comments:

Would you like to be on radio or television or be available for input on news articles, etc.?
Yes,  I would be interested in:  

How could you be of assistance to our public outreach efforts?  

Would you like to participate in a health fair? Yes No

Would you be willing to do a presentation? Yes No

Can you assist in drafting a news article about a program or event?  Yes No

From your point of view, what outreach efforts do you feel the communities are most interested in?

What ideas would you have that the Prevention and Outreach Department might be able to consider?  

OTHER COMMENTS

Tell us how to get in touch with you (voluntary):

Name
E-mail
Tel

[Four County Prevention & Outreach Department].
Revised: 07/08/08.