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Psychologist Patient Satisfaction Survey
Sample mode - Required questions are not validated
Psychologist Patient Satisfaction Survey

Questions prefixed with an * are required
*1. Which psychologist are/did you see?
*2. Ease of getting care
ExcellentGoodFairPoorN/A
Ability to get in to be seen
Hours Center is open
Convenience of Center's location
Prompt return on calls
*3. Please rate the following statements about your therapist
Strongly disagreeDisagreeNeutralAgreeStrongly agree
I feel supported and encouraged
The therapist understands my concerns and feelings
The therapist's approach is a good fit for me
Things I am learning in counselling are helping me to make positive changes
In our sessions we are covering what is important to me
I am comfortable with the direction we are taking in our sessions
I (or we) have clear goals for what I (or we) want to accomplish in counselling
I am (or We are) making a lot of progress on reaching these goals.
Counselling is helping me improve the quality of my life
Overall, counselling has been very helpful so far
*4. All other staff
ExcellentGoodFairPoorN/A
Friendly and helpful to you
Answers your questions
*5. Charges / Billing
ExcellentGoodFairPoorN/A
Cost of services
Explanation of charges
Collection of payment/money
*6. Facility
ExcellentGoodFairPoorN/A
Neat and clean building
Ease of finding where to go
Comfort and Safety while waiting
Privacy
*7. Would you refer us to your friends or relatives
8. What do you like best about our center
9. What do you like least about our Center
10. Suggestions for improvement
*11. Age
*12. Gender
*13. Race / Ethnicity

   

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