GENESIS ASSESSMENT SATISFACTION SURVEY

Question Title

* 1. Overall, how satisfied or dissatisfied were you with your last visit to Genesis Programs Inc?

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?

Very easy

Somewhat easy

Neither easy nor difficult

Somewhat difficult

Very difficult

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* 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?

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?

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.

	Very satisfied	Satisfied	Neither satisfied nor dissatisfied	Dissatisfied	Very Dissatisfied
Welcoming	Welcoming Very satisfied	Welcoming Satisfied	Welcoming Neither satisfied nor dissatisfied	Welcoming Dissatisfied	Welcoming Very Dissatisfied
Professionalism	Professionalism Very satisfied	Professionalism Satisfied	Professionalism Neither satisfied nor dissatisfied	Professionalism Dissatisfied	Professionalism Very Dissatisfied
Attentiveness	Attentiveness Very satisfied	Attentiveness Satisfied	Attentiveness Neither satisfied nor dissatisfied	Attentiveness Dissatisfied	Attentiveness Very Dissatisfied
Friendliness and Courtesy	Friendliness and Courtesy Very satisfied	Friendliness and Courtesy Satisfied	Friendliness and Courtesy Neither satisfied nor dissatisfied	Friendliness and Courtesy Dissatisfied	Friendliness and Courtesy Very Dissatisfied
Overall Customer Service Experience	Overall Customer Service Experience Very satisfied	Overall Customer Service Experience Satisfied	Overall Customer Service Experience Neither satisfied nor dissatisfied	Overall Customer Service Experience Dissatisfied	Overall Customer Service Experience Very Dissatisfied

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* 7. How well did the Clinician listen to your needs?

Extremely Well

Very Well

Somewhat Well

Not so Well

Not at all Well

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* 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?

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?

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?

Very satisfied

Somewhat satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

If dissatisfied, please help us improve our services by providing additional feedback:

Question Title

* 12. Overall, how would you rate the care you received from the Clinician?

Excellent

Very good

Good

Fair

Poor

Question Title

* 13. How likely is it that you would recommend Genesis Programs to a friend or family member?

Not at all likely

Extremely likely

GENESIS ASSESSMENT SATISFACTION SURVEY

Question Title

* 1. Overall, how satisfied or dissatisfied were you with your last visit to Genesis Programs Inc?

Question Title

* 2. How easy or difficult was it to schedule an appointment at a time that was convenient for you?

Question Title

* 3. Did your appointment with the assigned Clinician start early, late or on time?

Question Title

* 4. In your opinion, how convenient is the location of our Facility?

Question Title

* 5. How comfortable was the lobby and waiting area?

Question Title

* 6. Please indicate your level of satisfaction with the following items related to the Receptionist.

Question Title

* 7. How well did the Clinician listen to your needs?

Question Title

* 8. How responsive was the Clinician when answering your questions?

Question Title

* 9. How clear did the Clinician explain your treatment options?

Question Title

* 10. How much do you trust the recommendations of the Clinician?

Question Title

* 11. How satisfied or dissatisfied were you with the amount of time the Clinician spent with you addressing your needs?

Question Title

* 12. Overall, how would you rate the care you received from the Clinician?

Question Title

* 13. How likely is it that you would recommend Genesis Programs to a friend or family member?

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* 14. Is there anything we could have done to improve your last visit?