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Client Satisfaction Survey for Mental Health Private Practice
1.
How satisfied are you with our patient portal?
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
2.
How satisfied are you with our office staff?
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
3.
How satisfied are you with our scheduling process?
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
4.
How satisfied are you with the therapy you receive?
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
5.
Which therapeutic modalities have you found most helpful? (Select all that apply)
Cognitive Behavioral Therapy (CBT)
Dialectical Behavior Therapy (DBT)
Psychodynamic Therapy
Humanistic Therapy
Mindfulness-Based Therapy
EMDR
EFT Tapping
Somatic (Body Based)
6.
On a scale of 0 to 10,
How likely is it that you would recommend our practice to a friend or colleague?
0 for Not at all likely, 10 for Extremely likely
Not at all likely
Extremely likely
0
1
2
3
4
5
6
7
8
9
10
7.
How would you rate your overall experience with Open Minds Therapy, LLC?
Poor
1 heart
Neutral
2 hearts
Satisfied
3 hearts
Great
4 hearts
Outstanding
5 hearts
8.
Do you have any additional comments or suggestions to improve our services?
9.
Who is your therapist?
Kevin Daniels, LCSW, LCDP
Terrence Wright, NCC, LPC
Jillian Wiggins, NCC, LPC