Riverside County Department of Mental Health Mental Health Services Act Community Services and Supports 3-Year Plan



Feedback Form


Please submit this form by December 16, 2005. Forms can be submitted online at http://mentalhealth.co.riverside.ca.us/opencms/english/mhsa/ or mailed to: Riverside County Department of Mental Health, MHSA CSS Evaluations, PO Box 7549, Riverside, CA 92513.


What do you feel are the strengths of the plan? Please identify the
program and age group, if applicable.



What concerns do you have about the plan? Please identify the
program and age group, if applicable.



What region do you live in?




What group are you most associated with?








What is your gender?



What is your ethnicity?







What is your age?
0-17 yrs   18-24 yrs   25-59 yrs   60+ yrs  

Overall, how do you feel about the plan?
Very Satisfied   Somewhat Satisfied   Satisfied   Unsatisfied   Very Unsatisfied