Jun 12 2008 Survey
1.
How did you find our clinic?
Sent by physician
Online Search
Telephone order/catalogue
Word of mouth (if so who?)
Other  
  • Comment:

  • 500 characters left.
2.
How would you rate your overall level of satisfaction with us?
Highly satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Highly dissatisfied
3.
How would you rate your front office / customer service satisfaction with us?
Highly satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Highly dissatisfied
4.
How would you rate your therapy experience?
Highly satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Highly dissatisfied
  • Comment:

  • 500 characters left.
5.
How do we rate on the following attributes?
 Well Below Average Below Average Average Above Average Well Above Average 
On-time delivery of service
Professionalism
Quality of service
Understanding of clients' needs
Time spent with your therapist
Convenience of appointment times
  • Comment:

  • 500 characters left.
6.
How do we rate in comparison to other organizations that offer the same services?
Much higher
Somewhat higher
Same
Somewhat lower
Much lower
Don't know
7.
How likely are you to continue using our services?
Very likely
Somewhat likely
Neutral
Somewhat unlikely
Very unlikely
8.
Is there anyone in particular on our staff that you would like to recognize?
 

  • 350 characters left.
9.
Would you recommended us to others?
No, never recommended
Have recommended once or twice
Have recommended several times
10.
Do you have any suggestions for improvement?
 

  • 350 characters left.