Patient Satisfaction Survey

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* 2. How much would you say THS cares about you as a person?

THS always cares about me as a person.

THS often cares about me as a person.

THS sometimes cares about me as a person.

THS rarely cares about me as a person.

THS never cares about me as a person.

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* 3. To what extent does THS respect your beliefs, values and customs?

THS always respects my beliefs, values and customs.

THS often respects my beliefs, values and customs.

THS sometimes respects my beliefs, values and customs.

THS rarely respects my beliefs, values and customs.

THS never respects my beliefs, values and customs.

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* 4. To what extent did your counselor explain treatment?

My counselor and I always discuss my treatment.

My counselor and I often discuss my treatment.

My counselor and I sometimes discuss my treatment.

My counselor and I rarely discuss my treatment.

My counselor and I never discuss my treatment.

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* 5. To what extent did your counselor ask about your goals for treatment?

My counselor and I always discuss my treatment goals.

My counselor and I often discuss my treatment goals.

My counselor and I sometimes discuss my treatment goals.

My counselor and I rarely discuss my treatment goals.

My counselor and I never discuss my treatment goals.

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* 6. How often were you satisfied with scheduling appointments?

It is always easy to schedule or cancel an appointment.

It is often easy to schedule or cancel an appointment.

It is sometimes easy to schedule or cancel an appointment.

It is rarely easy to schedule or cancel an appointment.

It is never easy to schedule or cancel an appointment.

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* 7. How often were you satisfied with responses to e-mails and phone calls?

Responses to e-mails and phone calls are always prompt and helpful.

Responses to e-mails and phone calls are often prompt and helpful.

Responses to e-mails and phone calls are sometimes prompt and helpful.

Responses to e-mails and phone calls are rarely prompt and or helpful.

Responses to e-mails and phone calls are never prompt and or helpful.

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* 8. To what extent does THS really listen to you?

THS always listens to me.

THS often listens to me.

THS sometimes listens to me.

THS rarely listens to me.

THS never listens to me.

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* 9. To what extent does THS show you compassion?

THS always shows me compassion.

THS often shows me compassion.

THS sometimes shows me compassion.

THS rarely shows me compassion.

THS never shows me compassion.

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* 10. How often do you and your counselor discuss your family life?

My counselor always knows about my family life.

My counselor often knows about my family life.

My counselor sometimes knows about my family life.

My counselor rarely knows about my family life..

My counselor never knows about my family life.

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* 11. To what extent does your counselor include your family in your treatment?

My counselor always includes my family in my treatment.

My counselor often includes my family in my treatment.

My counselor sometimes includes my family in my treatment.

My counselor rarely includes my family in my treatment.

My counselor never includes my family in my treatment.

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* 12. To what extent do you feel your privacy and confidential information was respected?

My privacy and confidential information was always respected.

My privacy and confidential information was often respected.

My privacy and confidential information was sometimes respected.

My privacy and confidential information was rarely respected.

My privacy and confidential information was never respected.

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* 13. To what extent do you feel your health records were accessible?

My health records were always accessible.

My health records were often accessible.

My health records were sometimes accessible.

My health records were rarely accessible.

My health records were never accessible.

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* 14. To what extent do you feel the office was clean and well kept?

The office was always clean and well kept.

The office was often clean and well kept.

The office was sometimes clean and well kept.

The office was rarely clean and well kept.

The office was never clean and well kept.

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* 15. How often was the office comfortable?

The office was always comfortable.

The office was often comfortable.

The office was sometimes comfortable.

The office was rarely comfortable.

The office was never comfortable.

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* 16. How often were follow up appointments scheduled before you left?

Follow up appointments were always scheduled before I left.

Follow up appointments were often scheduled before I left.

Follow up appointments were sometimes scheduled before I left.

Follow up appointments were rarely scheduled before I left.

Follow up appointments were never scheduled before I left.

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* 17. How often were you charged the copay amount you agreed to?

I was always charged the copay amount I agreed to.

I was often charged the copay amount I agreed to.

I was sometimes charged the copay amount I agreed to.

I was rarely charged the copay amount I agreed to.

I was never charged the copay amount I agreed to.

Patient Satisfaction Survey

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* 1. Where did you receive services?

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* 2. How much would you say THS cares about you as a person?

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* 3. To what extent does THS respect your beliefs, values and customs?

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* 4. To what extent did your counselor explain treatment?

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* 5. To what extent did your counselor ask about your goals for treatment?

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* 6. How often were you satisfied with scheduling appointments?

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* 7. How often were you satisfied with responses to e-mails and phone calls?

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* 8. To what extent does THS really listen to you?

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* 9. To what extent does THS show you compassion?

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* 10. How often do you and your counselor discuss your family life?

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* 11. To what extent does your counselor include your family in your treatment?

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* 12. To what extent do you feel your privacy and confidential information was respected?

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* 13. To what extent do you feel your health records were accessible?

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* 14. To what extent do you feel the office was clean and well kept?

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* 15. How often was the office comfortable?

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* 16. How often were follow up appointments scheduled before you left?

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* 17. How often were you charged the copay amount you agreed to?

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* 18. Please describe (2) services Teri's Health Services provided very well.

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* 19. Please describe (2) services Teri's Health Services could improve.