Survey

SURVEY
No personal information is ever requested or collected. Your feedback is important

Clinic You Attend *

How did you here about us? *

Internet Search Friend Family Patient HealthCare Provider

If Other please specify: *

How satisfied are you with the program *

Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied

Do we provide higher quality care than other providers you have received services from for a similar issue *

Much Better Somewhat Better About the Same Somewhat Worse Much Worse

Did you receive a thorough orientation that helped you better understand your rights as a patient *

yes no

When you have a problem does your counselor help you find an appropriate referral to address the issue *

yes no yes, but referral didn't meet my needs

Select the option from the drop down that you would like us to improve upon *

Please feel free to offer any suggestions or complaints in the box below *

Submit