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Notice:

Existing users only

If you are a new client seeking services, please do not create your own client chart through using this link. The office will do so for you directly once your initial appointment is scheduled.

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SATISFACTION SURVEY

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Satisfaction Survey

Help Us Serve You Better

Your Experience Matters

Thank you for trusting us with your care. Your valuable feedback on this confidential survey helps us improve our services and continue to provide the best possible support for all of our clients.

Your Name (Required)

Your Email Address (Required)

Provider or Staff Member's Name (Required)

Date of Visit (Required)

Please indicate the type of service you are receiving: (Required)
TherapyEvaluation/ testingOther (administrative interactions)

Please rate your experience (1=Poor, 5=Excellent):

To what extent did your provider help you achieve your goals?

To what extent did your provider help you obtain new skills?

How well did your provider show interest in your needs?

How well did your provider understand your needs?

How well did your provider help you define your needs?

How well were you involved in treatment planning (goals, frequency)?

How well did your provider respond to your requests for services?

To what extent were you treated with dignity and respect?

Please rate the efficiency and accuracy of scheduling and billing:

Would you continue treatment or return to your provider in the future?
YesNo

Do you have any specific concerns or complaints about your treatment?
YesNo

If yes, please explain:

Were there some things you feel were especially good or helpful?
YesNo

If yes, please explain:

Please provide any additional comments:

By checking here, I give permission for my feedback to be posted anonymously to our internal staff morale board. Our staff love hearing how they are helping to make a difference!