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CAREERS
Let us know how we're doing by filling out the survey below!
Patient Satisfaction Survey
Thinking about your last visit, please indicate the type of practitioner you saw:
*
Psychiatrist (MD)
Nurse Practitioner (NP
Psychologist (PhD)
Mental Health Therapist/Counselor (LCSW, LPC)
Don't Know
Please Pick One
Visits with your Practitioner
Think about practitioner whom you saw your last visit, how would you rate him/her:
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Indicates required field
2. How prepared was this practitioner for your visit?
*
Excellent
Very Good
Good
Fair
Poor
N/A
3. Attention this practitioner paid to what you had to say:
*
Excellent
Very Good
Good
Fair
Poor
N/A
4. How well did this practitioner understand your concerns?
*
Excellent
Very Good
Good
Fair
Poor
N/A
5. Thoroughness and competence of this practitioner:
*
Excellent
Very Good
Good
Fair
Poor
N/A
6. Length of time between visits with this practitioner? (If you've only seen this practitioner once, mark N/A):
*
Excellent
Very Good
Good
Fair
Poor
N/A
Continuing to think about the visit you had with the practitioner on the date identified in the letter, please rate your agreement with the following statements:
7. This practitioner focused on achieving the goals for my counseling or treatment:
*
Excellent
Very Good
Good
Fair
Poor
N/A
8. This practitioner gave me as much information as I wanted about what I could do to manage my condition:
*
Excellent
Very Good
Good
Fair
Poor
N/A
9. This practitioner and other behavioral health practitioners, if any, worked as a team in coordinating my care:
*
Excellent
Very Good
Good
Fair
Poor
N/A
10. This practitioner and my primary medical doctor, if involved, worked as a team in coordinating my care:
*
Excellent
Very Good
Good
Fair
Poor
N/A
11. How likely would you be to recommend this practitioner to a friend or family member?
*
5 (Highly Recommend)
4
3
2
1 (Wouldn't Recommend)
Scheduling an Appointment
Your first call to DCBHS (before you had been matched with a practitioner) was with staff member employed by DCBHS. Thinking back to that phone call you made to DCBHS to get to an appointment, please rate your agreement with the following statements:
12. The person I talked with was friendly and helpful:
*
Excellent
Very Good
Good
Fair
Poor
N/A
13. The person I talked with matched me with a practitioner who was right for my needs and preferences:
*
Excellent
Very Good
Good
Fair
Poor
N/A
14. The first appointment was as soon as I wanted it:
*
Excellent
Very Good
Good
Fair
Poor
N/A
Behavioral Health Services in General
Thinking about the counseling or treatment you may have received through DCBHS
over the last 12 months
(this would include care received at the practitioner’s office listed in the letter), please respond to the following questions:
15. Friendliness and helpfulness of staff when you checked in:
*
Excellent
Very Good
Good
Fair
Poor
N/A
16. Ease of getting the counseling or treatment you believe is necessary:
*
Excellent
Very Good
Good
Fair
Poor
N/A
17. The information I received (materials, what staff/practitioners told me, etc.) was consistent:
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
18. All things considered, how satisfied are you with DCBHS for counseling or treatment?
*
Completely Satisfied
Very Satisfied
Somewhat Satisfied
Neither Satisfied or Dissatisfied
Somewhat Dissatisfied
Very Dissatisfied
Completely Dissatisfied
If you would like to make comments about your care, or have suggestions for how we can improve our service, please use the space provided in the space below:
Comment
*
Can we use your comment as a published testimonial?
*
Yes, use my intials (please provide at end of comments section)
Yes, but remain anonymous
I do not wish for my comment to be published.
Thank you so much for filling out our survey!
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