Client Satisfaction (Exit) Survey |

Client Satisfaction (Exit) Survey

Before you leave us…

Please take a few minutes to fill out this survey on the timeliness and quality of the service you received while you were here. Family Wellness Center welcomes your feedback and your answers will be kept confidential. Thank you for your participation.

1. How would you rate your overall experience here at FWC? *

Outstanding
Good
Adequate
Needs improvement
Poor

Comments

2. How well were your requirements for completing services explained to you? *

Outstanding
Good
Adequate
Needs improvement
Poor

Comments

3. How many sessions did you attend? *

First Visit
1-2 Weeks
3-6 Weeks
7-12 Weeks
More than 12

4. How satisfied were you with the behaviors of your counselor? *

Very dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied

5. Have your groups or individual sessions been useful to you? *

6. Did you feel actively involved in your services here at this agency? *

7. How would you rate the courtesy of the staff at the agency overall? *

Very Courteous
Courteous
Neutral
Rude
Very Rude

8. Please rate how clearly your financial obligations have been explained to you. *

Very unclearly
Unclearly
Clearly
Very clearly

9. How convenient were the days and times of your sessions for you *

Very convenient
Convenient
OK
Inconvenient
Very inconvenient

Comments

10. Do you feel that your services at FWC’s will help you in your life? *

11. How would you rate your current stress level related to your substance use? (copy) *

Not at all
A little
Somewhat
A lot
Very much

12. Would you recommend this facility and its staff to your family and friends? *

Additional Feedback

Name

Contact us to schedule an appointment.

3883 Rogers Bridge Road, Suite 202A, Duluth GA. 30097, U.S.A
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Phone Number: +1 (770) 545 8359
Fax Number: (229)-515-4233
info@familywellnesscenterllc.com