Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Are you currently attending the _________ clinic?

  • If so, how often do you attend? Who is your primary therapist?

  • Are you receiving other mental health treatment services in addition to the clinic?

  • Was the initial clinic appointment provided within a reasonable amount of time?

  • Do you feel welcomed when you visit the clinic?

  • Do you have the sense that you can be helped at this clinic? Are your needs met?

  • Do you feel that the clinic cares about you?

  • Do the goals and objectives listed on your treament plan match your needs and desires? Did you set your goals and objectives for your treatment plan?

  • Are the staff of the clinic respectful and sensitive to your culture?

  • Have you been prescribed any medication by the clinic psychiatrist? Have the benefits and side effects of your medications been discussed?

  • Has the clinic helped you to connect to activities outside the clinic such as peer support groups, spiritual suppor, or educational/recreational opportunities?

  • Do you believe the clinic staff memebers have made a sufficient effort to explain to your family/significant others how they can support your recovery?

  • Do you know the after hours crisis response system used by the clinic?

  • Have you ever used the after hours crisis response system?

  • Were you satisfied with the crisis response and assistance?

  • How could the crisis response system be improved?

  • Have you identified family members and/or significant others who can assist you during times of crisis?

  • Do you have a safety plan to be used during times of stress and/or emerging crisis?

  • Have you ever used the safety plan? If yes, did the plan work well and were adjustments made to the plan following the crisis?

  • On a scale of 1-10 how much do you feel the clinic services promote home and recovery?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.