Patient Satisfaction Questionnaire

Thank you for choosing Huron Valley Consultation Center. To provide the best possible service and treatment for our clients, we would like to know what we are doing well and what needs improvement, and we need your help to keep us informed. We want your honest opinion, whether positive or negative.

Please take a few moments to complete this questionnaire. Your feedback is very important to us. Please be assured that your responses are confidential and your recommendations will make a difference. We also welcome your comments and suggestions.

Date: 2020-11-25
Name of your therapist:
Name of your psychiatrist or nurse:
Thinking of your therapist, how would you rate:ExcellentVery goodGoodFairPoor
How well the treatment process was explained to you?[ Excellent ][ Very good ][ Good ][ Fair ][ Poor ]
How would you evaluate the success of your treatment by your therapist?[ Excellent ][ Very good ][ Good ][ Fair ][ Poor ]
Skill, knowledge, experience, and competency of your therapist?[ Excellent ][ Very good ][ Good ][ Fair ][ Poor ]
Politeness, respect, and dignity shown to you by your therapist?[ Excellent ][ Very good ][ Good ][ Fair ][ Poor ]
How likely is it that you would return to the same therapist in the future?[ Excellent ][ Very good ][ Good ][ Fair ][ Poor ]
If you also saw a psychiatrist or nurse for medications, please answer these questions:ExcellentVery goodGoodFairPoor
How well did your psychiatrist or nurse explain your medications, treatment, and condition?[ Excellent ][ Very good ][ Good ][ Fair ][ Poor ]
Skill, knowledge, experience, and competency?[ Excellent ][ Very good ][ Good ][ Fair ][ Poor ]
Politeness, respect, and dignity shown to you?[ Excellent ][ Very good ][ Good ][ Fair ][ Poor ]
How would you evaluate the success of your treatment?[ Excellent ][ Very good ][ Good ][ Fair ][ Poor ]
How likely is it that you would return to the same psychiatrist or nurse in the future?[ Excellent ][ Very good ][ Good ][ Fair ][ Poor ]
How would you rate the office staff on:ExcellentVery goodGoodFairPoor
Promptness and efficiency?[ Excellent ][ Very good ][ Good ][ Fair ][ Poor ]
Politeness, friendliness, and courtesy shown to you?[ Excellent ][ Very good ][ Good ][ Fair ][ Poor ]
Handling of your bill?[ Excellent ][ Very good ][ Good ][ Fair ][ Poor ]
Concern for your privacy?[ Excellent ][ Very good ][ Good ][ Fair ][ Poor ]
Overall, how would you rate Huron Valley Consultation Center?ExcellentVery goodGoodFairPoor
How would you rate the quality of the service you received?[ Excellent ][ Very good ][ Good ][ Fair ][ Poor ]
How satisfied are you with the amount of help you have received?[ Excellent ][ Very good ][ Good ][ Fair ][ Poor ]
How satisfied are you that the services provided were what you needed?[ Excellent ][ Very good ][ Good ][ Fair ][ Poor ]
How hopeful are you about the relief and recovery from the problem(s) that brought you here?[ Excellent ][ Very good ][ Good ][ Fair ][ Poor ]
How likely is it that you would return to HVCC in the future?[ Excellent ][ Very good ][ Good ][ Fair ][ Poor ]
If a friend or family member were in need of similar help, what is the likelihood you would recommend HVCC to him or her?[ Excellent ][ Very good ][ Good ][ Fair ][ Poor ]
The cleanliness and comfort of the facility?[ Excellent ][ Very good ][ Good ][ Fair ][ Poor ]
Are there improvements we should make?
Do you have any other comments?
Thank you for completing this questionnaire. If you would like us to respond to your comments, please include your name and phone number.
Name:
Phone Number: