Mental Health Satisfaction Survey Question Title * 1. How long have you been going to Samantha Cole? Less than 6 months At least 6 months but less than 1 year At least 1 year but less than 3 years At least 3 years but less than 5 years 5 years or more Question Title * 2. How well did your provider listen to your needs? Extremely well Very well Moderately well Slightly well Not at all well Question Title * 3. How well did your provider answer your questions? Extremely well Very well Moderately well Slightly well Not at all well Question Title * 4. Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate Samantha Cole? 10 Best provider possible 9 8 7 6 5 4 3 2 1 0 Worst provider possible . . 10 Best provider possible . 9 . 8 . 7 . 6 . 5 . 4 . 3 . 2 . 1 . 0 Worst provider possible Question Title * 5. In the last 12 months, when you phoned your healthcare provider’s office during regular office hours, how often did you get an answer to your medical question that same day? Never Sometimes Usually Always Question Title * 6. In general, how would you rate your overall mental or emotional health? Excellent Very good Good Fair Poor Question Title * 7. In the last 12 months, how often did Samantha Cole explain things in a way that was easy to understand? Never Sometimes Usually Always Question Title * 8. Would you recommend Samantha Cole’s office to your family and friends? Yes, definitely Yes, somewhat No Question Title * 9. Do you have any other comments, questions, or concerns? Question Title * 10. Are you male or female? Male Female Done