Client Satisfaction Survey

THANK YOU FOR COMING TO WALK-IN AND COMPLETING THIS SURVEY!

This survey is completely anonymous. It is 9 questions and takes about 2 minutes. Please complete this survey only once.

Question Title

* 1. Which best describes your visit to Walk-In? Choose one.

Un-scheduled

Scheduled appointment

Question Title

* 2. Did you connect by. . .

Phone

Computer login

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* 3. How did you find out about our services?

Someone who knew about or had used the service

Internet search

Professional referred me (suggested it, sent me a flier, etc.)

Saw it on Facebook

Saw an ad (newspaper, newsletter, etc.)

Other (tell us how)

Question Title

* 4. Check any of these factors that you considered in choosing our service.

Free/no insurance needed

Anonymous

No appointment needed

Convenient clinic times

Good reputation

Counselors are mental health professionals

Other (please specify)

Question Title

* 5. How satisfied are you with the services you received?

Very satisfied

Mostly satisfied

Don't know

Somewhat dissatisfied

Very dissatisfied

Other (we'd love your feedback)

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* 6. As a result of coming I feel more hopeful that I can handle things.

Yes, absolutely

Yes, I think so

Don't know

No, not really

No, I feel much worse

Other (please specify)

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* 7. If a friend or loved one were in need, I would recommend this service.

Yes, absolutely

Probably

Don't know

No, definitely not

Please tell us more!

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* 8. What is your approximate household income?

$50,000 and higher

$30,000 - $50,000

Less than $30,000

Have no idea

Prefer not to say

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* 9. How do you describe your race/ethnicity? (Check all that apply)

White/Caucasian

Black/African American

African Immigrant

Hispanic or Latinx

Asian/Asian American

American Indian

Mixed Race

Pacific Islander

Other