Client Satisfaction Survey - Synchrony Psychological Services

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1. How would you rate the quality of service you received?

	Excellent	Good	Fair	Poor	Other
Please choose:	*How would you rate the quality of service you received? Please choose: Excellent	Please choose: Good	Please choose: Fair	Please choose: Poor	Please choose: Other

Comments (optional):

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2. Did you receive the type of service you wanted/needed?

	Yes, Definitely	Yes, Somewhat	No, Not Really	No, Definitely Not
Please Choose:	*Did you receive the type of service you wanted/needed? Please Choose: Yes, Definitely	Please Choose: Yes, Somewhat	Please Choose: No, Not Really	Please Choose: No, Definitely Not

Additional Comments (optional):

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3. Would you feel comfortable referring a friend of colleague for services?

	Yes, Definitely	Yes, I think so	No, I don't think so	No, definitely not	Other
Please choose:	*Would you feel comfortable referring a friend of colleague for services? Please choose: Yes, Definitely	Please choose: Yes, I think so	Please choose: No, I don't think so	Please choose: No, definitely not	Please choose: Other

Additional Comments (optional):

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4. How satisfied are you with the help you have received?

	Very satisfied	Mostly satisfied	Indifferent or mildly dissatisfied	Quite dissatisfied	Other
Please Choose:	*How satisfied are you with the help you have received? Please Choose: Very satisfied	Please Choose: Mostly satisfied	Please Choose: Indifferent or mildly dissatisfied	Please Choose: Quite dissatisfied	Please Choose: Other

Additional comments (optional):

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5. I felt comfortable sharing my concerns with my psychologist

	Strongly Agree	Agree	Disagree	Strongly Disagree	Other
Please choose:	*I felt comfortable sharing my concerns with my psychologist Please choose: Strongly Agree	Please choose: Agree	Please choose: Disagree	Please choose: Strongly Disagree	Please choose: Other

Additional comments (optional):

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6. Please indicate the degree to which you found these qualities within the therapist/therapy you experienced:

	Yes, Very Much	Yes, Somewhat	Perhaps, Not sure	Definitely Not	Other (see comments)
Good Judgement	*Please indicate the degree to which you found these qualities within the therapist/therapy you experienced: Good Judgement Yes, Very Much	Good Judgement Yes, Somewhat	Good Judgement Perhaps, Not sure	Good Judgement Definitely Not	Good Judgement Other (see comments)
Patience and Acceptance	Patience and Acceptance Yes, Very Much	Patience and Acceptance Yes, Somewhat	Patience and Acceptance Perhaps, Not sure	Patience and Acceptance Definitely Not	Patience and Acceptance Other (see comments)
Experience	Experience Yes, Very Much	Experience Yes, Somewhat	Experience Perhaps, Not sure	Experience Definitely Not	Experience Other (see comments)
Education	Education Yes, Very Much	Education Yes, Somewhat	Education Perhaps, Not sure	Education Definitely Not	Education Other (see comments)
Social Skills	Social Skills Yes, Very Much	Social Skills Yes, Somewhat	Social Skills Perhaps, Not sure	Social Skills Definitely Not	Social Skills Other (see comments)
Genuineness and Warmth	Genuineness and Warmth Yes, Very Much	Genuineness and Warmth Yes, Somewhat	Genuineness and Warmth Perhaps, Not sure	Genuineness and Warmth Definitely Not	Genuineness and Warmth Other (see comments)
Discretion	Discretion Yes, Very Much	Discretion Yes, Somewhat	Discretion Perhaps, Not sure	Discretion Definitely Not	Discretion Other (see comments)

Additional Comments (Optional)

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7. Have the services you received helped you to deal more effectively with your problem?

	Yes, they helped a great deal	Yes, they helped	No, they didn't seem to help	No, they seem to have made things worse	Other
Please Choose:	*Have the services you received helped you to deal more effectively with your problem? Please Choose: Yes, they helped a great deal	Please Choose: Yes, they helped	Please Choose: No, they didn't seem to help	Please Choose: No, they seem to have made things worse	Please Choose: Other

Additional comments:

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8. Please indicate your level of satisfaction with each of the elements below:

	Completely Satisfied	Mostly Satisfied	Needs Improvement	Disappointing	Other
Telephone Calls/Emails returned promptly	*Please indicate your level of satisfaction with each of the elements below: Telephone Calls/Emails returned promptly Completely Satisfied	Telephone Calls/Emails returned promptly Mostly Satisfied	Telephone Calls/Emails returned promptly Needs Improvement	Telephone Calls/Emails returned promptly Disappointing	Telephone Calls/Emails returned promptly Other
Appointment scheduling and availability	Appointment scheduling and availability Completely Satisfied	Appointment scheduling and availability Mostly Satisfied	Appointment scheduling and availability Needs Improvement	Appointment scheduling and availability Disappointing	Appointment scheduling and availability Other
Payment Options	Payment Options Completely Satisfied	Payment Options Mostly Satisfied	Payment Options Needs Improvement	Payment Options Disappointing	Payment Options Other
Office cleanliness	Office cleanliness Completely Satisfied	Office cleanliness Mostly Satisfied	Office cleanliness Needs Improvement	Office cleanliness Disappointing	Office cleanliness Other
Office location	Office location Completely Satisfied	Office location Mostly Satisfied	Office location Needs Improvement	Office location Disappointing	Office location Other
Office furnishing	Office furnishing Completely Satisfied	Office furnishing Mostly Satisfied	Office furnishing Needs Improvement	Office furnishing Disappointing	Office furnishing Other

Additional Comments:

9. We love to receive feedback in order to continue to improve the quality of service that we provide. Please use the box below to provide additional feedback, comments, suggestions or questions. Because this feedback is anonymous, if you would like to be contacted about any of the information you have included in this survey, please include your name and the best means by which to contact you (e.g., email, telephone). We will be happy to do so in the very near future!

We love to receive feedback in order to continue to improve the quality of service that we provide. Please use the box below to provide additional feedback, comments, suggestions or questions. Because this feedback is anonymous, if you would like to be contacted about any of the information you have included in this survey, please include your name and the best means by which to contact you (e.g., email, telephone). We will be happy to do so in the very near future!

10. Would you be comfortable with content from the survey you have just completed being included as 'client testimonial' information on our website at: www.innersynchrony.ca / www.tanyatinney.ca?

Would you be comfortable with content from the survey you have just completed being included as 'client testimonial' information on our website at: www.innersynchrony.ca / www.tanyatinney.ca?   Yes	No
Please indicate whether you are comfortable with including your name and/or initials on the website testimonial information: