Consumer Satisfaction Survey Therapy/Tutoring Services 25% of survey complete. Thank you for answering this survey. It is used in part to evaluate staff and also make improvements in the program. Question Title * 1. Your Name (Optional) Question Title * 2. Most Recent Date of Service Date of service Date Question Title * 3. Clinician's Name or Department you were seen by Question Title * 4. Your Clinician or Department seen by Needs Improvement Fair Average Very Good Excellent N/A Staff knowledge and skills Staff knowledge and skills Needs Improvement Staff knowledge and skills Fair Staff knowledge and skills Average Staff knowledge and skills Very Good Staff knowledge and skills Excellent Staff knowledge and skills N/A Staff listened and communicated well Staff listened and communicated well Needs Improvement Staff listened and communicated well Fair Staff listened and communicated well Average Staff listened and communicated well Very Good Staff listened and communicated well Excellent Staff listened and communicated well N/A Staff considered my input Staff considered my input Needs Improvement Staff considered my input Fair Staff considered my input Average Staff considered my input Very Good Staff considered my input Excellent Staff considered my input N/A Staff developed individualized treatment goals Staff developed individualized treatment goals Needs Improvement Staff developed individualized treatment goals Fair Staff developed individualized treatment goals Average Staff developed individualized treatment goals Very Good Staff developed individualized treatment goals Excellent Staff developed individualized treatment goals N/A Progress made Progress made Needs Improvement Progress made Fair Progress made Average Progress made Very Good Progress made Excellent Progress made N/A Recommendations and/or referrals, when needed Recommendations and/or referrals, when needed Needs Improvement Recommendations and/or referrals, when needed Fair Recommendations and/or referrals, when needed Average Recommendations and/or referrals, when needed Very Good Recommendations and/or referrals, when needed Excellent Recommendations and/or referrals, when needed N/A Next