Client Satisfaction Survey
Is this your first time in our office?
Yes
No
Overall, how satisfied are you with the services you receive at Graceful Therapy?
Not Satisfied
1
2
3
4
5
6
7
8
9
Very Satisfied
10
1 is Not Satisfied, 10 is Very Satisfied
How satisfied were you with the intake process?
Not Satisfied
1
2
3
4
5
6
7
8
9
Very Satisfied
10
1 is Not Satisfied, 10 is Very Satisfied
How long did you typically wait (in the waiting room or virtual waiting room) for your provider to greet you/start session?
Less than 5 min
10-15 min.
15-30 min.
30 min. - 45 min.
Clinician never showed
How satisfied are you with your therapist?
Not Satisfied
1
2
3
4
5
6
7
8
9
Very Satisfied
10
1 is Not Satisfied, 10 is Very Satisfied
How effective has your therapy experience been at alleviating your symptoms?
Not Effective
1
2
3
4
5
6
7
8
9
Very Effective
10
1 is Not Effective, 10 is Very Effective
Please rate the following
Professionalism of staff
1
2
3
4
5
Office Cleanliness & Comfort
1
2
3
4
5
Ease of scheduling regular sessions
1
2
3
4
5
Billing & Insurance Use
1
2
3
4
5
How likely would you recommend to your friends/family?
Not Likely
1
2
3
4
5
6
7
8
9
Very Likely
10
1 is Not Likely, 10 is Very Likely
Please share any comments, suggestions, or concerns
Would you like to provide a statement of recommendation for our services? Please note, this not required and your name will not be included on any sharing of this statement.
How did you hear about Graceful Therapy?
Please Select
Facebook Group Recommendation
Friend or Family Member is already a client
Doctor or Psychiatry Referral
Google Ad
Other
Submit
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