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* 1. Your/Your Child's Therapist's Name:

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* 2. How old are you or your minor child? 

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* 3. How long have you or your minor child been seeing this therapist?

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* 4.  I feel my therapist understands me and my experiences / My child and I feel the therapist understands my child and his/her experiences

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* 5. I feel that my therapist collaborates with me regarding my therapy / My child and I feel that his/her therapist collaborates with me and my child about his/her therapy

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* 6. I feel helped by my therapist / My child & I feel s/he is being helped by the therapist

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* 7. My therapist is sensitive to my racial and cultural identity / My child's therapist is sensitive to our racial and cultural identity

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* 8. I feel that I can talk to my therapist about disagreements, frustrations, or concerns I have with him/her or the therapy / I feel my child and I can talk to his/her therapist about disagreements, frustrations, or concerns s/he or I have with the therapist or the therapy

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* 9. I feel that my therapist is knowledgeable about the issues we talk about in therapy / My child and I feel that the therapist is knowledgeable about the issues addressed in the therapy

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* 10. I trust my therapist / My child and I trust his/her therapist

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* 11. Overall, I am satisfied with the clinical care provided by my therapist / Overall, my child and I are satisfied with the clinical care provided by my child's therapist

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* 12. Please add any comments you would like to share about your therapist / your child's therapist

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* 13. The Presby Psych receptionist is respectful and professional

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* 14. Making a first appointment with Presby Psych was a satisfactory experience

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* 15. The initial Client Information paperwork  at Presby Psych is reasonable

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* 16. My questions about cancellation policies and other clinical policies are answered promptly and respectfully

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* 17. The billing staff at Presby Psych is respectful and professional

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* 18. I am satisfied with the financial statements I receive

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* 19. My financial questions are answered accurately and respectfully

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* 20. Please add any comments you would like to share about our receptionist, paperwork, and/or billing staff 

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* 21. Would you recommend Presby Psych to a friend or relative?

Thank you for completing this survey. 
Presbyterian Psychological Services
5203 Sharon Road
Charlotte, NC 28210
(704) 554-9900
www.presbypsych.org

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