1. How would you rate the following CLINIC SERVICES:

  Poor Fair Satisfactory Good Excellent
Performance of the student clinician?
Progress you/your child made with therapy this semester?
Communication of the student clinician with you after each therapy session?
Willingness of the student clinician to carefully listen to you?
Willingness of the student clinician to take time to answer your questions?
Ability of the student clinician to explain things in a way you could understand?
Advice given regarding follow-up therapy?
Service you received during the evaluation/assessment process? (new clients only)

2. How would you rate the following aspects of the CLINIC FACILITY:

  Poor Fair Satisfactory Good Excellent
Overall appearance of the facility?
Appearance of the therapy room?
Accessibility of the facility?
Facility’s parking?
Overall comfort of the facility?

3. How would you rate the following characteristics of the CLINIC STAFF:

  Poor Fair Satisfactory Good Excellent
Friendliness of the staff/students?
Knowledge of the staff/students?
Communication between the student clinician and the client?
Interaction between the student clinician and the client?
Professionalism of the student clinician (manner, dress, etc.)?

4. What do you like most about our clinic?

5. What can we do to improve our services?

6. Do you feel like your needs are met regarding clinical services? If not, why? Or, if so – please elaborate.

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