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Satisfaction Survey

We want to hear from you!

Please share your review of the services you received. Note that your survey will remain confidential unless you would like to provide your name and contact information for further discussion about your treatment. We do our best to ensure our clients have quality care, and we appreciate your feedback.
1.Please indicate the type of services you received:
2.Are you a new or returning client?(Required.)
3.Client:
4.Provider:
5.Your Appointment:
Excellent
Very Good
Fair
Poor
Terrible
N/A
Ease of making appointments
Appointment available within a reasonable amount of time
Waiting time in the reception area
Staff checked on you and offered assistance
Ease of getting a referral when you needed one
6.Our Staff:
Excellent
Very Good
Fair
Poor
Terrible
N/A
The friendliness and courtesy of the office staff
The professionalism of our staff
Getting advice or help when needed during office hours
Our ability to return your calls in a timely manner
Your ability to obtain medication
The quality of your care
7.Your Visit With The Provider:
Excellent
Very Good
Fair
Poor
Terrible
N/A
Willingness to listen carefully to you
Taking time to answer your questions
Involved you in the treatment planning (such as setting goals and frequency of appointments)
Helped you achieve the purpose for which you sought services
Taught skills that will help you handle future problems
Provided an opportunity to make lasting meaningful change
8.Our Facility:
Excellent
Very Good
Fair
Poor
Terrible
N/A
Hours of operation convenient for you
Adequate parking
Signage and directions easy to follow
Office was clean, comfortable, and inviting
Overall satisfaction with care from provider and staff
9.Would you recommend our practice to others?(Required.)
10.If there is any way we can improve our services to you, please tell us about it: