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Chicago Psych Therapy Group Patient Satisfaction Survey
Please fill out the survey to better improve our care to our patients. All answers are 100% anonymous and HIPAA compliant.
1.
Who is your provider at the Chicago Psych Therapy Group?
2.
Overall, how satisfied or dissatisfied were you with your last visit to our office?
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
3.
On a scale of 0 to 10,
How likely is it that you would recommend your provider to a friend or family member?
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
4.
Did your appointment with your provider start early, late or on time?
Very early
Somewhat early
On time
Somewhat late
Very late
5.
Overall, how would you rate the care you received from your provider?
Excellent
Very good
Good
Fair
Poor
6.
How well did your provider listen to your needs?
Extremely well
Very well
Somewhat well
Not so well
Not at all well
7.
How well did your provider explain your treatment options?
Extremely well
Very well
Somewhat well
Not so well
Not at all well
8.
How well did your provider answer your questions?
Extremely well
Very well
Somewhat well
Not so well
Not at all well
9.
Do you have concerns you would like to speak to someone about? If so, please give the best phone number to reach you at.