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A Peace of Mind Wellness Satisfaction Survey

Please complete the survey below based on the satisfaction with the services.
1.What is your name? (not required to answer)
2.Are you a guardian, client, or referral source?
3.If you are a guardian, how long has your child been in treatment with us?
4.Are you satisfied with communication from your worker?
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
Unsure
5.How satisfied are you with your progress since working with A Peace of Mind Wellness?
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
Unsure
6.Do you feel that you are treated well by staff?
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
Unsure
7.Have you been explained all of the services offered by A Peace of Mind Wellness?
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
Unsure
8.Is the facility a comfortable, clean, and easily accessible setting?
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
Unsure
9.Are you or were you given the opportunity to express a problem or file a complaint regarding the treatment and/or services?
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
N/A
10.I would rate my overall level of satisfaction with A Peace of Mind Wellness as:
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
Unsure
11.Please list three areas of improvement related to your treatment here at A Peace of Mind Wellness.
12.Additional Comments:
THANK YOU for taking time to complete this survey and assist us in making our services the BEST!
Any questions or concerns, please email Jen Fackelman at Jenfackelman@apeaceofmindwellness.com