Main Line Therapy Solutions Satisfaction Survey

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* 1. How likely is it that you would recommend MLTS to a friend or colleague?

NOT AT ALL LIKELY

EXTREMELY LIKELY

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* 2. Overall, how satisfied or dissatisfied are you with scheduling your appointments?

Very satisfied

Somewhat satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

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* 3. How would you rate the quality of the services you have received?

Very high quality

High quality

Neither high nor low quality

Low quality

Very low quality

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* 4. How responsive have we been to any questions or concerns you've had about our practice or services?

Extremely responsive

Very responsive

Somewhat responsive

Not so responsive

Not at all responsive

Not applicable

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* 5. How long have you and/or a family member been a client of MLTS?

This is my first appointment

Less than one month

Less than 3 months

3-6 months

Over 6 months

Over a year

Over 3 years

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* 6. What is the name of your clinician?

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* 7. Which of the following words would you use to describe your experience working with your clinician?

Reliable

Knowledgeable

Helpful and/or supportive

Friendly

Ineffective

Responsive

Lacked warmth

Professional

Effective

Unreliable

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* 8. How many stars would you give your clinician with 5 being the best?

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* 9. How many stars would you give our office environment with 5 being the best?

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* 10. Do you have any comments, questions, or concerns you'd like to share with us?

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* 11. Would you like one of our Directors to contact you regarding any of your responses?

Yes

If yes, how should we contact you?