Client Satisfaction Survey

Client Satisfaction Survey
Survey Completion Date*

MonthDayYear
Date
Please select the services you receive from HWS Best Health*

CounselingCase ManagementMedication Management/PsychiatryOther
Please provide the name(s) of your providers*
How satisfied are you with the booking process (becomming a new client)?*

1

2

3

4

5

6

7

8

9

10

1 is Not Satisfied, 10 is Very Satisfied

Please rate the following*

	Not Satisfied	Somewhat Satisfied	Satisfied	Very Satisfied
The amount of time your therapist is with you
The amount of help you and your family received
Responsiveness of Staff
Friendliness of Staff
Professionalism of Staff
Knowledge of Staff
Quality of Care

How satisfied are you with your provider(s) overall?*

1

2

3

4

5

6

7

8

9

10

1 is Not Satisfied, 10 is Very Satisfied
By considering overall experience with us, how likely would you recommend to your friends/family?*

1

2

3

4

5

6

7

8

9

10

1 is Not Likely, 10 is Very Likely
Please share any comments/suggestions
If you would like to be contacted regarding your submission, please provide your name, telephone number and email address that we can reach you at
Name

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