Discharge Follow Up
Please enter your name/title and agency:
Please enter the consumer's first and
last name:
Please select the approximate
Discharge Month and year from Hope
Services, LLC.
Please select the type
of service(s) received
through Hope
Services, LLC.*For multiple
selections press the Control Key
Current Placement
Please indicate
consumer's current
placement and
mental health
services. *For multiple
selections press the Control Key
Current Mental Health Services
Is the consumer currently maintaining an
appropriate level of functioning? (If no, please
comment)
Does the consumer currently need any additional
services? (If yes, please list under comments)
Please enter any
comments here:
Thank you for taking
the time to provide us
with follow up
information.  This
information will assist
us in tracking the
effectiveness of our
services.  Please feel
free to contact us
directly if you would
like to provide
additional information
regarding a consumer.  

We know that your
time is valuable, and
we appreciate your
willingness to
complete this brief
follow up survey.