Patient Satisfaction Survey

We would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Your responses are directly responsible for improving the work we do. All responses will be kept confidential and anonymous. Thank you for your time.

Your Age

Gender

Male Female

Your Race/Ethnicity

Please select how well you think we are doing in the following areas

(1:Poor, 2:Fair, 3:OK, 4:Good, 5:Great):

EASE OF GETTING CARE

Ability to get in to be seen:

1 2 3 4 5

Hours Healing Minds, LLC is open:

1 2 3 4 5

Convenience of location:

1 2 3 4 5

Prompt return on calls:

1 2 3 4 5

WAITING

Time in waiting room:

1 2 3 4 5

Time with Clinician:

1 2 3 4 5

Waiting room is comfortable:

1 2 3 4 5

Parking is accessible:

1 2 3 4 5

Staff

PROVIDER (PHYSICIAN, THERAPIST)

Listens to you:

1 2 3 4 5

Takes enough time with you:

1 2 3 4 5

Explains what you want to know:

1 2 3 4 5

Clinician is a competent professional:

1 2 3 4 5

STAFF

Friendly and helpful to you:

1 2 3 4 5

Answers your questions:

1 2 3 4 5

All Others

Friendly and helpful to you:

1 2 3 4 5

Answers your questions:

1 2 3 4 5

Payment

What you pay:

1 2 3 4 5

Explanation of charges:

1 2 3 4 5

Collection of payment/money:

1 2 3 4 5

Facility

Neat and clean building:

1 2 3 4 5

Ease of finding where to go:

1 2 3 4 5

Comfort and Safety while waiting:

1 2 3 4 5

Privacy:

1 2 3 4 5

Confidentiality

Keeping my personal information private:

1 2 3 4 5

General

The likelihood of referring your friends and relatives to us:

1 2 3 4 5

Is Healing Minds your primary mental health provider?

Yes No

What do you like best about Healing Minds?

What do you think we could improve at Healing Minds?

Suggestions or comments?

3 + 4 = ?