Client Satisfaction Survey

Client Satisfaction SurveyCharles Perry2022-08-31T10:36:03+00:00

Please Fill Out This Survey

Your input is very important to us. We would like to hear from you about what we are doing well, as well as what we can improve. All responses are reviewed carefully and given serious consideration. Please take a few minutes to give us your feedback. Feel free to include a description of any extraordinary service. You may submit this survey anonymously or sign it if you prefer. Please include the name of the doctor or therapist you are rating.

If the survey doesn’t let you submit it, try clicking the submit button again or refreshing the page.

My Doctor/therapist is courteous, respectful and professional.

Selected Value: 0

1 ) Very Dissatisfied 2) Somewhat Dissatisfied 3) Satisfied 4) Very Satisfied 5) Beyond Satisfied

My Doctor/therapist is caring and concerned.

Selected Value: 0

1 ) Very Dissatisfied 2) Somewhat Dissatisfied 3) Satisfied 4) Very Satisfied 5) Beyond Satisfied

My Doctor/therapist helped me to change my life in positive ways.

Selected Value: 0

1 ) Very Dissatisfied 2) Somewhat Dissatisfied 3) Satisfied 4) Very Satisfied 5) Beyond Satisfied

My treatment goals were explained and I agreed.

Selected Value: 0

1 ) Very Dissatisfied 2) Somewhat Dissatisfied 3) Satisfied 4) Very Satisfied 5) Beyond Satisfied

My Doctor/therapist is easy to contact and/or returns calls or emails promptly.

Selected Value: 0

1 ) Very Dissatisfied 2) Somewhat Dissatisfied 3) Satisfied 4) Very Satisfied 5) Beyond Satisfied

To what extent do you feel that your therapy here helped you live a better life?

Selected Value: 0

1 ) Very Dissatisfied 2) Somewhat Dissatisfied 3) Satisfied 4) Very Satisfied 5) Beyond Satisfied

Please Provide the Name of Your Provider *

Based on the care you received, if you were to rate Specialized Therapy Associates on a 1 to 5 scale with 5 being outstanding, how would you rate us?

Selected Value: 0

1 ) Very Dissatisfied 2) Somewhat Dissatisfied 3) Satisfied 4) Very Satisfied 5) Beyond Satisfied

It was easy to contact an intake counselor and arrange an appointment

Selected Value: 0

1 ) Very Dissatisfied 2) Somewhat Dissatisfied 3) Satisfied 4) Very Satisfied 5) Beyond Satisfied

The intake counselor clearly explained my insurance and co-pay information.

Selected Value: 0

1 ) Very Dissatisfied 2) Somewhat Dissatisfied 3) Satisfied 4) Very Satisfied 5) Beyond Satisfied

Office staff are helpful and knowledgeable.

Selected Value: 0

1 ) Very Dissatisfied 2) Somewhat Dissatisfied 3) Satisfied 4) Very Satisfied 5) Beyond Satisfied

Appointments are scheduled at times that are convenient.

Selected Value: 0

1 ) Very Dissatisfied 2) Somewhat Dissatisfied 3) Satisfied 4) Very Satisfied 5) Beyond Satisfied

Are you satisfied with how we handle your billing?

Selected Value: 0

1 ) Very Dissatisfied 2) Somewhat Dissatisfied 3) Satisfied 4) Very Satisfied 5) Beyond Satisfied

Based on your experience, please rate your overall impression of administrative and billing staff.

Selected Value: 0

1 ) Very Dissatisfied 2) Somewhat Dissatisfied 3) Satisfied 4) Very Satisfied 5) Beyond Satisfied

Were you informed of our specialty services, groups and programs?

Yes
No

Would you recommend your therapist or Specialized Therapy Associates to a friend or family member?

Yes
No

If answered no, please explain why not?

Was there anything you enjoyed in your therapy or any feedback you would like to leave:

May we use your comments and ratings in a confidential way for marketing? *

Yes
No

If Yes to the question above, please sign/ e-sign here

Check here if you would like the Director to Contact you.

I would like to be contacted by the Director

If you would like to be contacted by the director, please provide a Name and a Phone number

Title