EAP Client Satisfaction Survey

Employee Assistance Program-Client Satisfaction Survey

Dear Bloomington Hospital employee or family member:

This survey is intended to help improve the services provided by Employee Assistance Program (EAP). Your participation is important if Bloomington Hospital is to provide the finest possible EAP services. Please take a moment to complete this response regarding your experience with EAP. Your name is NOT part of the information requested and confidentiality is our uppermost concern. This form is to be provided to each Bloomington Hospital employee or family member utilizing the EAP services. Thank you for participating.

Question Title

1. How did you learn or hear about EAP?

Co-worker

Supervisory recommendation

Family member

The Employee Benefits Fair

Previous visit to EAP

Poster, pamphlet or other type of promotional information

Advertisement in the Molecule

Other (please specify)

Question Title

2. How many sessions did you attend?

Question Title

3. Concerning Office Staff:
Using the rating scale provided, please indicate your resonse to the following questions:

	Very Poor	Poor	Fair	Good	Very Good
When you called for the initial appointment, how helpful was the person to whom you spoke in answering your questions?	When you called for the initial appointment, how helpful was the person to whom you spoke in answering your questions? Very Poor	When you called for the initial appointment, how helpful was the person to whom you spoke in answering your questions? Poor	When you called for the initial appointment, how helpful was the person to whom you spoke in answering your questions? Fair	When you called for the initial appointment, how helpful was the person to whom you spoke in answering your questions? Good	When you called for the initial appointment, how helpful was the person to whom you spoke in answering your questions? Very Good
Once you scheduled your appointment, how would you rate the waiting time before being seen for your first visit?	Once you scheduled your appointment, how would you rate the waiting time before being seen for your first visit? Very Poor	Once you scheduled your appointment, how would you rate the waiting time before being seen for your first visit? Poor	Once you scheduled your appointment, how would you rate the waiting time before being seen for your first visit? Fair	Once you scheduled your appointment, how would you rate the waiting time before being seen for your first visit? Good	Once you scheduled your appointment, how would you rate the waiting time before being seen for your first visit? Very Good
How would you rate the customer service of staff (professional, knowledgeable, respectful, friendly)?	How would you rate the customer service of staff (professional, knowledgeable, respectful, friendly)? Very Poor	How would you rate the customer service of staff (professional, knowledgeable, respectful, friendly)? Poor	How would you rate the customer service of staff (professional, knowledgeable, respectful, friendly)? Fair	How would you rate the customer service of staff (professional, knowledgeable, respectful, friendly)? Good	How would you rate the customer service of staff (professional, knowledgeable, respectful, friendly)? Very Good

Comments

Question Title

4. Concerning the EAP Therapist:
Using the rating scale provided, please indicate your response to the following questions:

	Very Poor	Poor	Fair	Good	Very Good
How would you rate your satisfaction with the value of the information provided in helping to resolve your issue?	How would you rate your satisfaction with the value of the information provided in helping to resolve your issue? Very Poor	How would you rate your satisfaction with the value of the information provided in helping to resolve your issue? Poor	How would you rate your satisfaction with the value of the information provided in helping to resolve your issue? Fair	How would you rate your satisfaction with the value of the information provided in helping to resolve your issue? Good	How would you rate your satisfaction with the value of the information provided in helping to resolve your issue? Very Good
How would you rate the level of respect and courtesy shown to you by the counselor?	How would you rate the level of respect and courtesy shown to you by the counselor? Very Poor	How would you rate the level of respect and courtesy shown to you by the counselor? Poor	How would you rate the level of respect and courtesy shown to you by the counselor? Fair	How would you rate the level of respect and courtesy shown to you by the counselor? Good	How would you rate the level of respect and courtesy shown to you by the counselor? Very Good
How well do you believe your concerns were addressed in counseling sessions?	How well do you believe your concerns were addressed in counseling sessions? Very Poor	How well do you believe your concerns were addressed in counseling sessions? Poor	How well do you believe your concerns were addressed in counseling sessions? Fair	How well do you believe your concerns were addressed in counseling sessions? Good	How well do you believe your concerns were addressed in counseling sessions? Very Good

Comments

Question Title

5. If referrals were made for further services (i.e., therapists, self-help groups, etc), did you pursue the referral?

Yes

No referrals were made

Question Title

6. If you decided to use the referral suggestions, how helpful are/were these services?

Very Poor

Poor

Fair

Good

Very Good

Not applicable

Comments

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Question Title

1. How did you learn or hear about EAP?

Question Title

2. How many sessions did you attend?

Question Title

3. Concerning Office Staff:Using the rating scale provided, please indicate your resonse to the following questions:

Question Title

4. Concerning the EAP Therapist:Using the rating scale provided, please indicate your response to the following questions:

Question Title

5. If referrals were made for further services (i.e., therapists, self-help groups, etc), did you pursue the referral?

Question Title

6. If you decided to use the referral suggestions, how helpful are/were these services?

3. Concerning Office Staff:
Using the rating scale provided, please indicate your resonse to the following questions:

4. Concerning the EAP Therapist:
Using the rating scale provided, please indicate your response to the following questions: