Client Satisfaction Survey

Client Satisfaction Survey

We value your opinion, and ask that you please take a few minutes to complete this survey about your experience at KERNERSVILLE COUNSELING CENTER. Your responses will not effect your treatment in any way.
Name of Client

First NameLast Name
Name of guardian completing this form (if client is a minor)

First NameLast Name
Email
example@example.com
Which therapist do you work with at KCC?
How long have you (or your child) been a client at KCC?

Less than 3 months3 - 6 months6 months - 1 year1 - 2 yearsMore than 2 years
How long did you have to wait to be scheduled once you inquired about services?

Less than 2 weeks3 - 4 weeks5 - 6 weeks7 - 8 weeksMore than 2 months
Overall, I am satisfied with the counseling services that I am receiving at KCC

Strongly agreeAgreeSomewhatNot really
My therapist starts and ends my appointments on time

AlwaysMost of the timeSometimesRarely
I have never had to wait more than 10 minutes past my appointment time

TrueFalse
My therapist understands my problems/concerns

Strongly agreeAgreeSomewhatNot really
I am confident in the skills of my therapist

Strongly agreeAgreeSomewhatNot really
My therapist is attentive and compassionate

Strongly agreeAgreeSomewhatNot really
I feel respected and accepted by staff at KCC

Strongly agreeAgreeSomewhatNot really
I am making progress towards my treatment goals

Strongly agreeAgreeSomewhatNot really
I would recommend KCC to my family and friends

YesNoNot sure
If you have any specific complaints or concerns, please let us know so that we can address it.
We always welcome your thoughts! Please provide us with any comments or suggestions for improving our services.
If you would like to be contacted regarding your experience with KCC, please enter your contact information here.
Thank you for completing this survey.

We appreciate your business.
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Client Satisfaction Survey

Thank you for completing this survey.