Customer Service Satisfaction Survey
Client's Name
*
First Name
Last Name
Please rate how strongly you are satisfied with each of the statements.
*
Rows
Not Satisfied
Somewhat Satisfied
Satisfied
Very Satisfied
Not Applicable
Professionalism of the company
Responsiveness to questions and needs
Service quality
Performance of the admin staff
Ease of scheduling an appointment
Please rate how strongly you agree or disagree with each of the statements.
*
Rows
Totally
Disagree
Somewhat Disagree
Somewhat
Agree
Totally
Agree
Not Applicable
Location is easy to find.
Office is easily reachable by phone/email.
Company representatives always meet my expectations.
Information provided always met my needs.
I would recommend Balance Beacon to others.
Did you receive financial information about your visit prior to attending?
*
Yes, I understood how much I did/did not have to pay prior to my first visit
No, I did not receive any payment information before my first visit.
Overall, how satisfied are you with our customer service?
*
1
2
3
4
5
First Visit Experience
Please tell us a little bit about your first session with your therapist.
Who did you see?
*
Caresse Okafor, LPC-A
Genniffer Williams, LPC, LMFT
Dr. LaFonya Jones-Hines
Dr. Nichelle Wall
Dr. Reshaunda Strickland
Please rate your satisfaction with your therapist
*
Rows
Not Satisfied
Somewhat Satisfied
Satisfied
Very Satisfied
Friendly
Understood my problem/need
Educated me about the therapy process.
Answered my questions or concerns
Do you believe your therapist was a good fit for your needs?
*
Yes
No
I'm not sure as of right now.
If no or unsure, please provide additional information.
Continuing therapy?
*
I've scheduled (or need to) follow up appointments with my therapist
I'd like help connecting with another therapist (we will call or email you to get that set up)
I am not interested in scheduling a follow up appointment.
Do you have any feedback for us to improve your experience or the experience of future clients?
Overall experience with your therapist
*
1
2
3
4
5
Submit
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