Client Satisfaction Survey Form

Client Satisfaction Survey

Please, read and respond accordingly to every question asked below
Name*

First Name Last Name
What program do you attend?*

Overall satisfaction of service

	Very Poor	Poor	Good	Very Good	Excellent
Did the staff acknowledge you promptly upon your arrival?
Was the staff courteous and helpful?
Was the staff respectful and discrete?
Was the participation in this agency's programs worth your time?
Was the staff responsive to your questions, issues or needs?
Did the staff encourage you to participate in our services that we offer?
Did the facility helped you to solve any problems?
Were the appointment times given in a way that is flexible so that you could complete services?
Please rate your level of satisfaction with our services you received
Would you recommend our agency to anyone you know?