GENESIS ASSESSMENT SATISFACTION SURVEY
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1.
Overall, how satisfied or dissatisfied were you with your last visit to Genesis Programs Inc?
(Required.)
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
If dissatisfied, please provide additional feedback to help us imrove our services.
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2.
How easy or difficult was it to schedule an appointment at a time that was convenient for you?
(Required.)
Very easy
Somewhat easy
Neither easy nor difficult
Somewhat difficult
Very difficult
3.
Did your appointment with the assigned Clinician start early, late or on time?
Very early
Early
On time
Late
Very late
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4.
In your opinion, how convenient is the location of our Facility?
(Required.)
Extremely convenient
Very convenient
Somewhat convenient
Not so convenient
Not at all convenient
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5.
How comfortable was the lobby and waiting area?
(Required.)
Extremely comfortable
Very comfortable
Somewhat comfortable
Not so comfortable
Not at all comfortable
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6.
Please indicate your level of satisfaction with the following items related to the Receptionist.
(Required.)
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very Dissatisfied
Welcoming
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very Dissatisfied
Professionalism
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very Dissatisfied
Attentiveness
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very Dissatisfied
Friendliness and Courtesy
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very Dissatisfied
Overall Customer Service Experience
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very Dissatisfied
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7.
How well did the Clinician listen to your needs?
(Required.)
Extremely Well
Very Well
Somewhat Well
Not so Well
Not at all Well
8.
How responsive was the Clinician when answering your questions?
Extremely responsive
Very responsive
Somewhat responsive
Not so responsive
Not at all responsive
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9.
How clear did the Clinician explain your treatment options?
(Required.)
Extremely clearly
Very clearly
Somewhat clearly
Not so clearly
Not at all clearly
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10.
How much do you trust the recommendations of the Clinician?
(Required.)
A great deal of trust
A lot of trust
A moderate amount of trust
A little trust
Not any trust at all
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11.
How satisfied or dissatisfied were you with the amount of time the Clinician spent with you addressing your needs?
(Required.)
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
If dissatisfied, please help us improve our services by providing additional feedback:
*
12.
Overall, how would you rate the care you received from the Clinician?
(Required.)
Excellent
Very good
Good
Fair
Poor
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13.
On a scale of 0 to 10,
How likely is it that you would recommend Genesis Programs to a friend or family member?
0 for Not at all likely, 10 for Extremely likely
(Required.)
Not at all likely
Extremely likely
0
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10
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14.
Is there anything we could have done to improve your last visit?
(Required.)