Main Line Therapy Solutions Satisfaction Survey Question Title * 1. How likely is it that you would recommend MLTS to a friend or colleague? NOT AT ALL LIKELY EXTREMELY LIKELY 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 OK Question Title * 2. Overall, how satisfied or dissatisfied are you with scheduling your appointments? Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied OK Question Title * 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 OK Question Title * 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 OK Question Title * 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 OK Question Title * 6. What is the name of your clinician? OK Question Title * 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 OK Question Title * 8. How many stars would you give your clinician with 5 being the best? OK Question Title * 9. How many stars would you give our office environment with 5 being the best? OK Question Title * 10. Do you have any comments, questions, or concerns you'd like to share with us? OK Question Title * 11. Would you like one of our Directors to contact you regarding any of your responses? Yes No If yes, how should we contact you? OK DONE