Patient Satisfaction Survey

Name (OPTIONAL)

First

Last

1. Your Therapist

2. Number of Visits

4. Appointment availability (within 5 business days of your request)

3. The Online Scheduling Option

5. The Online Intake Form Option

6. Hours of operation (10:00 a.m. to 6:30 p.m.)

7. Ease of making an appointment

8. Keeping you informed of your appointment time

9. Ease of using driving directions and signage

10. Ease of parking

11. Ease of building accessibility

13. Waiting time in the reception area

14. Ease of check-in

12. Ease of using public transportation

13. Overall Comfort (restrooms, drinking water, comfort of furniture, temperature, etc)

14. Ease of contacting us after hours (phone, text and email) (within 24 hours)

15. The professionalism of your therapist

16. Therapist’s willingness to listen to you carefully and patiently

17. You and your therapist had clearly established goals

18. Therapist’s ability to clearly explain the strategy used to achieve your goals

19. Effectiveness of therapy strategy

20. Your Treatment Plan was provided upon request

21. Time was taken to answer your questions completely

22. Adequate time was spent with you (45/60 minutes)

23. Ease of getting an alternative or additional referral if you needed one

24. Your ability to obtain a psychiatric referral

25. The overall quality of your care

26. The likelihood you would recommend our practice to your friends and others

If there is anything you believe we can do to improve our services, please tell us about it.

Email (Optional)