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Online Satisfaction Survey
The purpose of this survey is to gather feedback to inform and improve the quality of our services. Your candid input is very much appreciated. Written comments are especially welcome and helpful. Thank you!
Instructions
Questions on this survey are followed by a 1-10 scale. 1 being "not satisfied at all" and 10 being "highly satisfied." Please choose the number that best expresses your opinion. There are also questions that ask you to identify a response simply by checking a box. Your name on this survey is not required.
Approximate number of sessions to date:
Office you were primarily seen in?
Type of therapy provided:
Clear selection
Name of Therapist:
Therapy Experience
During the first three sessions my therapist communicated an understanding of what brought me to treatment and what I would like to work on.
Not Satisfied at All
Highly Satisfied
Clear selection
My counselor appeared to have (or had) a genuine interest in my welfare.
Not Satisfied at All
Highly Satisfied
Clear selection
My therapist helps (or helped) me to better understand myself.
Not Satisfied at All
Highly Satisfied
Clear selection
I feel satisfied with the progress I am making (or have made) in therapy.
Not Satisfied at All
Highly Satisfied
Clear selection
My therapist seems (seemed) knowledgeable and experienced.
Not Satisfied at All
Highly Satisfied
Clear selection
My therapist integrated my spiritual beliefs into treatment. (If applicable)
Not Satisfied at All
Highly Satisfied
Clear selection
Office/Administrative
Samaritan's policies regarding insurance/fees, confidentiality and scheduling were made clear to me.
Not Satisfied at All
Highly Satisfied
Clear selection
The administrative support staff were helpful and courteous.
Not Satisfied at All
Highly Satisfied
Clear selection
The therapist who contacted me was prompt in responding to my request for counseling.
Not Satisfied at All
Highly Satisfied
Clear selection
The waiting room was comfortable and pleasant.
Not Satisfied at All
Highly Satisfied
Clear selection
Short Answer
Why did you choose Samaritan over other counseling providers?
Do you have any additional suggestions for improved service?
Would you recommend us to a friend or family member?
Clear selection
If no, please explain:
If you have ended counseling please choose a reason for this decision:
If other, please explain:
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