OP Client Satisfaction Session Survey

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* 1. Please provide your name and email address. Thank you. Please note: it is confidential and secure. You do not have to provide this information if you are uncomfortable. It can remain confidential.

Name:

Email Address:

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* 2. Date of Session:

Date

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* 3. Clinic Location

Onalaka

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* 4. This was my:

First Appointment

Follow Up Appointment

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* 5. My counselor is:

Brienne Shaker

Tommy Moize

Ted Stein

Sherrie Walter

Cathy Routh

Maria Towle

Don Kube

Kendel Berning

Josie Brown

Allison Gerdes

McKenzi (Cook) Sloniker

Rachel Boehm

Cortney Grady

Sean Barel

Sylvester Sullivan

Jennifer TeBeest

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* 6. Please answer based your experience of the reception process

	Strongly Disagree	Diagree	Agree	Strongly Agree	N/A
The receptionist was warm and welcoming	The receptionist was warm and welcoming Strongly Disagree	The receptionist was warm and welcoming Diagree	The receptionist was warm and welcoming Agree	The receptionist was warm and welcoming Strongly Agree	The receptionist was warm and welcoming N/A
Other (please specify)
The receptionist was friendly on the phone	The receptionist was friendly on the phone Strongly Disagree	The receptionist was friendly on the phone Diagree	The receptionist was friendly on the phone Agree	The receptionist was friendly on the phone Strongly Agree	The receptionist was friendly on the phone N/A
Other (please specify)
The receptionist was helpful on the phone	The receptionist was helpful on the phone Strongly Disagree	The receptionist was helpful on the phone Diagree	The receptionist was helpful on the phone Agree	The receptionist was helpful on the phone Strongly Agree	The receptionist was helpful on the phone N/A
Other (please specify)
The waiting room is inviting and welcoming	The waiting room is inviting and welcoming Strongly Disagree	The waiting room is inviting and welcoming Diagree	The waiting room is inviting and welcoming Agree	The waiting room is inviting and welcoming Strongly Agree	The waiting room is inviting and welcoming N/A
Other (please specify)
The receptionist worked with me to find therapy times that worked with my schedule	The receptionist worked with me to find therapy times that worked with my schedule Strongly Disagree	The receptionist worked with me to find therapy times that worked with my schedule Diagree	The receptionist worked with me to find therapy times that worked with my schedule Agree	The receptionist worked with me to find therapy times that worked with my schedule Strongly Agree	The receptionist worked with me to find therapy times that worked with my schedule N/A
Other (please specify)
Overall, I am very satisfied with the reception I received at Stein Counseling	Overall, I am very satisfied with the reception I received at Stein Counseling Strongly Disagree	Overall, I am very satisfied with the reception I received at Stein Counseling Diagree	Overall, I am very satisfied with the reception I received at Stein Counseling Agree	Overall, I am very satisfied with the reception I received at Stein Counseling Strongly Agree	Overall, I am very satisfied with the reception I received at Stein Counseling N/A
Other (please specify)

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* 7. All of us at Stein Counseling and Consulting Services want to do the best job we can. We want to know how we are doing and that means we want to know what YOU think. We would appreciate it if you would take a few minutes to read each question below and tell us how we are doing. Please be HONEST . . . we want to know what we do well and what we can do better so we can do our very best for you! Thank you.

	Strongly Disagree	Diagree	Agree	Strongly Agree
I felt heard	I felt heard Strongly Disagree	I felt heard Diagree	I felt heard Agree	I felt heard Strongly Agree
I felt understood	I felt understood Strongly Disagree	I felt understood Diagree	I felt understood Agree	I felt understood Strongly Agree
I felt respected	I felt respected Strongly Disagree	I felt respected Diagree	I felt respected Agree	I felt respected Strongly Agree
I developed new insights	I developed new insights Strongly Disagree	I developed new insights Diagree	I developed new insights Agree	I developed new insights Strongly Agree
The therapist challenged me at the right moments on the right topics (when applicable)	The therapist challenged me at the right moments on the right topics (when applicable) Strongly Disagree	The therapist challenged me at the right moments on the right topics (when applicable) Diagree	The therapist challenged me at the right moments on the right topics (when applicable) Agree	The therapist challenged me at the right moments on the right topics (when applicable) Strongly Agree
We worked on what I wanted to work on	We worked on what I wanted to work on Strongly Disagree	We worked on what I wanted to work on Diagree	We worked on what I wanted to work on Agree	We worked on what I wanted to work on Strongly Agree
We talked about what I wanted to talk about	We talked about what I wanted to talk about Strongly Disagree	We talked about what I wanted to talk about Diagree	We talked about what I wanted to talk about Agree	We talked about what I wanted to talk about Strongly Agree
The therapist's approach is a good fit for me	The therapist's approach is a good fit for me Strongly Disagree	The therapist's approach is a good fit for me Diagree	The therapist's approach is a good fit for me Agree	The therapist's approach is a good fit for me Strongly Agree
Overall, today's session was right for me	Overall, today's session was right for me Strongly Disagree	Overall, today's session was right for me Diagree	Overall, today's session was right for me Agree	Overall, today's session was right for me Strongly Agree

Other (please specify)

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* 8. The session began on time

Yes

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* 9. The session ended on time

Yes

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* 10. Overall, how well did the SCCS Service Provider meet your expectations in the session?

	Poor	Below Average	Average	Above Average
Professional	Professional Poor	Professional Below Average	Professional Average	Professional Above Average
Knowledgable	Knowledgable Poor	Knowledgable Below Average	Knowledgable Average	Knowledgable Above Average
Skillful	Skillful Poor	Skillful Below Average	Skillful Average	Skillful Above Average
Communication	Communication Poor	Communication Below Average	Communication Average	Communication Above Average

Other (please specify)

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* 11. Based on your session today:How likely are you to:

	Very Unlikely	Unlikely	Likely	Very Likely
Recommend Stein Counseling Services to others?	Recommend Stein Counseling Services to others? Very Unlikely	Recommend Stein Counseling Services to others? Unlikely	Recommend Stein Counseling Services to others? Likely	Recommend Stein Counseling Services to others? Very Likely
Recommend this provider to other people?	Recommend this provider to other people? Very Unlikely	Recommend this provider to other people? Unlikely	Recommend this provider to other people? Likely	Recommend this provider to other people? Very Likely
Want to Work with this provider again?	Want to Work with this provider again? Very Unlikely	Want to Work with this provider again? Unlikely	Want to Work with this provider again? Likely	Want to Work with this provider again? Very Likely

Other (please specify)

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* 12. May we contact you with questions regarding your survey?

Yes

OP Client Satisfaction Session Survey

1. Default Section

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* 1. Please provide your name and email address. Thank you. Please note: it is confidential and secure. You do not have to provide this information if you are uncomfortable. It can remain confidential.

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* 2. Date of Session:

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* 3. Clinic Location

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* 4. This was my:

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* 5. My counselor is:

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* 6. Please answer based your experience of the reception process

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* 8. The session began on time

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* 9. The session ended on time

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* 10. Overall, how well did the SCCS Service Provider meet your expectations in the session?

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* 11. Based on your session today:How likely are you to:

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* 12. May we contact you with questions regarding your survey?

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* 13. Email Address

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