Client Satisfaction Survey-English

Client Satisfaction Survey

Please help us improve our services by answering some questions about your experience at/with Family Service of El Paso. The survey should take 3-4 minutes. We are interested in your honest feedback, whether it is positive or negative. Your responses will not affect your current or future treatment. If you would like to keep your responses anonymous, do not write your name at the end of the survey.
Contact Information

Providing us your contact information is not mandatory, your responses and feedback will remain confidential and will not be used against you in any way. This is to incentivize you for making the effort to complete this survey. This will help us reach out to you if you win the movie ticket drawing.
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
What type of service have you received? (please select all that apply)

Individual sessionsFamily sessionsCouples sessions
How many sessions have you attended?
Who referred you to Family Service of El Paso? (i.e doctor, friend, internet, etc..)
Please indicate how much you agree or disagree with the following statements by selecting the options below. If you have had more than one therapist at Family Service, please answer the questions about the therapist with whom you interacted the most.
My therapist has been supportive of me during sessions:

Strongly DisagreeDisagreeSlightly DisagreeSlightly AgreeAgreeStrongly Agree
My therapist has treated me respectfully during sessions:

Strongly DisagreeDisagreeSlightly DisagreeSlightly AgreeAgreeStrongly Agree
My therapist has understood the concerns I shared during sessions:

Strongly DisagreeDisagreeSlightly DisagreeSlightly AgreeAgreeStrongly Agree
My therapist has helped me feel comfortable during sessions:

Strongly DisagreeDisagreeSlightly DisagreeSlightly AgreeAgreeStrongly Agree
I am satisfied with how easy it was to register for services:

Strongly DisagreeDisagreeSlightly DisagreeSlightly AgreeAgreeStrongly Agree
I am satisfied with the time it took for me to be assigned a therapist:

Strongly DisagreeDisagreeSlightly DisagreeSlightly AgreeAgreeStrongly Agree
I am satisfied with how beneficial the therapy sessions have been for me:

Strongly DisagreeDisagreeSlightly DisagreeSlightly AgreeAgreeStrongly Agree
I am satisfied with how much I have progressed on my therapy goals:

Strongly DisagreeDisagreeSlightly DisagreeSlightly AgreeAgreeStrongly Agree
I would recommend these services to a loved one with a similar problem:

Strongly DisagreeDisagreeSlightly DisagreeSlightly AgreeAgreeStrongly Agree
Were there any parts of your experience with Family Service that you liked more than others?
Do you have any suggestions for how the services you received could be improved?
Additional Comments:
Would you like the Executive Director to contact you regarding a concern?
Please provide us with your contact information & we will be happy to reach you:
Name

First NameLast Name
Best way to be contacted:
Phone Number
Please enter a valid phone number.
Email
example@example.com
Should be Empty:

Client Satisfaction Survey

Contact Information

Please indicate how much you agree or disagree with the following statements by selecting the options below. If you have had more than one therapist at Family Service, please answer the questions about the therapist with whom you interacted the most.

Please provide us with your contact information & we will be happy to reach you: