Patient Satisfaction Survey
We would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Your responses are directly responsible for improving these services. All responses will be kept confidential and anonymous. Thank you for your time.
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Gender Identity: *
Race/Ethnicity:
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Ease of Getting Care
Ability to get in to be seen: *
Poor
Great
Hours the Center is open: *
Poor
Great
Convenience of Center's location: *
Poor
Great
Prompt return on calls: *
Poor
Great
Waiting
Time in waiting room: *
Poor
Great
Time in session room: *
Poor
Great
Waiting for tests: *
Poor
Great
Waiting for test results: *
Poor
Great
Staff: Counselors
Listens to you: *
Poor
Great
Takes enough time with you: *
Poor
Great
Explains what you want to know: *
Poor
Great
Gives you good advice and treatment: *
Poor
Great
Staff: Non-counselors
Friendly and helpful to you: *
Poor
Great
Answers your questions: *
Poor
Great
Payment
What you pay: *
Poor
Great
Explanation of charges: *
Poor
Great
Collection of payment/money: *
Poor
Great
Facility
Neat and clean building: *
Poor
Great
Ease of finding where to go: *
Poor
Great
Comfort and safety while waiting: *
Poor
Great
Privacy: *
Poor
Great
Confidentiality
Keeping my personal information private: *
Poor
Great
Referrals
Likelihood of referring your friends to us: *
Poor
Great
Do you consider this center your regular source of care? *
What do you like best about our center?
What do you like least about our center?
Suggestions for improvement?
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