2021 Patient Survey
This survey will be used for provider and agency feedback. No individual patient names are needed to complete the survey.
OK
1.
Please provide the name of your provider.
2.
I feel supported and understood by my provider.
Agree
Disagree
3.
I am able to use what I learn here to make improvements in my life.
Yes
No
4.
Is there anything that would be more helpful about your treatment?
5.
Do you feel your provider is a good fit for you? What works well and what improvements could be made?
6.
Is the office clean, comfortable, and enjoyable? Are there improvements you would like to see in the treatment setting?
7.
Any other comments you would like to add?
Current Progress,
0 of 7 answered