Client Satisfaction Survey
If you or a loved one recently received services from Forensic Consultation & Counseling Service, we would appreciate your feedback on the care you experienced. Your feedback will help us learn what you liked and what we can do to better meet our community's needs. Please answer the following questions and hit the "submit" button when you have completed the survey. If you would like to receive a reply, please include your contact information.
Race / Ethnicity *
Age *
Age at the time of services
Were you mandated into treatment? *
Did something force you to complete treatment...i.e: Probation and Parole
What did you enter treatment for?
What factors motivated you to being services? (Select all that apply)
Still Engaged in Services *
Are you still receiving services from our program?
Ease of Getting Care: *
Excellent
Good
Fair
Poor
N/A
Ability to get in to be seen
Hours office open
Convenience of location
Prompt return of phone calls
Waiting: *
Excellent
Good
Fair
Poor
N/A
Time taken for initial phone call
Time taken for first appointment
Time to be seen for follow up appointments
Provider *
Excellent
Good
Fair
Poor
N/A
Listens to you
Takes enough time with you
Addresses your needs
Gives good suggestions and treatment
Returns your calls
Follows through on requests
Program: *
Excellent
Good
Fair
Poor
N/A
Centered around your needs
Group addressed specific issues
Charges and Billing: *
Excellent
Good
Fair
Poor
N/A
Cost of Services
Collection of payment
Options for payments
How did you pay for services?
Did you use insurance. sliding fee etc...
Facility: *
Excellent
Good
Fair
Poor
N/A
Neat and Clean Building
Comfort and Safety
Privacy
Waiting Area
Offices
Group Rooms
Would you refer your friends and relatives to us?
What did you like most about Forensic Consultation & Counseling Service?
Your answer
What did you like least about Forensic Consultation & Counseling Service?
Your answer
Services Terminated
Why did you stop services?
Suggestions for Improvement
What would you recommend we change?
Your answer
Name and Phone Number
If you would like staff to contact you, please enter your information
Your answer
Your answer
Submit
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This form was created inside of Forensic Consultaion and Counseling Service, LLC.