We would like to ask you about your experience with our office. Thank you for helping us continue to improve the care we provide for our clients.

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* 1. Overall, how satisfied were you with your last visit to our office?

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* 2. Overall, how would you rate the service you received at the reception area of our office?

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* 3. Did your appointment with your therapist start early, late or on time?

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* 4. How well did your therapist listen to your needs and concerns?

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* 5. How satisfied are you with the cleanliness and appearance of our facility?

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* 6. Did your appointment with your psychiatrist start early, late, or on time?

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* 7. How would you rate the Psychiatrist's "bed-side" manner?

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* 8. How likely is it that you would recommend our facility to a friend or family member?

Not at all likely
Extremely likely

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* 9. Is there anything we could do to improve our services?

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* 10. Were there any employees who provided you with exceptional service? (If yes, please identify them by name)

T