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Client Satisfaction QA 2026
Please provide your thoughts about NBWC providers, your care and support, your mobility, and our quality of service we provided for you.
OK
1.
(Optional) Contact Information
Name
Address
City/Town
State/Province
ZIP/Postal Code
Email Address
Phone Number
2.
Do you have weekly appointments with your provider?
Yes
Usually
No
Comments:
3.
Is your provider punctual?
Yes
Usually
No
Comments:
4.
Does your
provider cancel or reschedule appointments frequently?
Yes
Usually
No
Comments:
5.
How would you rate the professionalism and competence of your clinician and/or advocates?
Far above average
Above average
Average
Below average
Far below average
Comments:
6.
Did you receive a detailed explanation of the services and the role of the provider during the first session?
Yes
Usually
No
Comments:
7.
Does your clinician and/or advocate do well when assessing your health care needs?
Yes
Usually
No
8.
Is your provider sensitive to your culture and beliefs?
Yes
Usually
No
Comments:
9.
Has the provider made any referrals to provide support? (Ex; medication management, Therapeutic Mentor, OP, IHT, group therapy, etc.).
Yes
Usually
No
If Yes, What were the referrals for?
10.
Do you feel the provider answers any questions that you have regarding referrals and other services?
Yes
Usually
No
Comments:
11.
Overall, Are you satisfied with our teletherapy system?
Yes
Usually
No
Comments:
12.
Did your provider discuss and explain to you the legal consents during the first session?
Yes
Usually
No
Comments:
13.
Do you feel your provider has a clear understanding of your needs?
Yes
Usually
No
Comments:
14.
Is your clinician and/or advocate clear in their explanation of your treatment option and goals?
Yes
Usually
No
Comments:
15.
Do you feel your treatment goals are being met?
Yes
Usually
No
Comments:
16.
Did your provider discuss and explain to you the safety plan?
Yes
Usually
No
Comments:
17.
Do you think your provider and/or team attends to your needs in a timely manner?
Yes
Usually
No
Comments:
18.
When calling the office, is the phone answered quickly?
Yes
Usually
No
N/A
19.
Are they polite and courteous?
Yes
Usually
No
N/A
20.
When leaving a message is the provider quick to call back?
Yes
Usually
No
Comments:
21.
Do you feel your providers are helpful?
Yes
Usually
No
Comments:
22.
Are you overall satisfied with the services you are receiving?
Yes
Usually
No
Comments:
23.
Will you recommend our services?
Yes
Usually
No
Comments:
24.
If Unhappy, do you know how to make a complaint?
Yes
Usually
No
Comments:
25.
What can we change to give you a better service?
26.
Questions 27 and on only apply to Clients receiving IHT/TTS and TM services. If you do NOT receive these services please select N/A for each question and submit.
Which services do you receive? Choose all that apply.
IHT-In Home Therapy
TTS- Therapeutic Training and Support
TM- Therapeutic Mentor
OP- Outpatient Therapy
MM- Medication Management
27.
Do you meet with your team at least once a month?
Yes
No
Usually
N/A
28.
Did your provider discuss and sign with you the consent to transport a minor?
Yes
Usually
No
N/A
29.
Do you feel the minor is safe when being transported?
Yes
Usually
No
N/A
30.
Does the provider communicate with you when the client is being picked up or dropped off at the house?
Yes
Usually
No
N/A
Current Progress,
0 of 30 answered
