Customer Satisfaction Survey Customer Survey "*" indicates required fields Name (Optional)Please rate the timely manner in which your appointments were scheduled.*(Were you able to get in to see your provider in a timely manner) 1: Poor 2: Fair 3: Good 4: Excellent Please rate your satisfaction with the customer service line.*(Was the Call Center rep courteous, knowledgeable, caring, professional) 1: Poor 2: Fair 3: Good 4: Excellent How would you rate your satisfaction with the compassion shown to you at your visit?* 1: Poor 2: Fair 3: Good 4: Excellent Please rate your satisfaction with the frequency of visits to your prescribing practitioner.* 1: Poor 2: Fair 3: Good 4: Excellent How would you rate the cleanliness of the waiting room?* 1: Poor 2: Fair 3: Good 4: Excellent How would you rate the professionalism of the front office staff?* 1: Poor 2: Fair 3: Good 4: Excellent How courteous was the front office staff?* 1: Poor 2: Fair 3: Good 4: Excellent Ability of your counselor(s) to listen to and understand your problems.* 1: Poor 2: Fair 3: Good 4: Excellent Professional knowledge and competence of the main counselor.* 1: Poor 2: Fair 3: Good 4: Excellent How would you rate the quality of care received from your counselor?* 1: Poor 2: Fair 3: Good 4: Excellent If applicable, please rate the quality of care you received from your prescriber. 1: Poor 2: Fair 3: Good 4: Excellent 5: N/A Confidentiality and respect for your rights as an individual?* 1: Poor 2: Fair 3: Good 4: Excellent How would you rate the overall services received at your visit?* 1: Poor 2: Fair 3: Good 4: Excellent Degree to which the services have helped you deal more effectively with your problem.* 1: Poor 2: Fair 3: Good 4: Excellent While at your visit, were all your concerns addressed?* 1: Poor 2: Fair 3: Good 4: Excellent Did the staff demonstrate genuine concern for you?* 1: Poor 2: Fair 3: Good 4: Excellent Who is the Provider you are seeing?*In your own words, please explain any concerns or complaints that this survey has not addressed:Would you like a response to your concerns?* Yes No Phone NumberCaptcha