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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 these services. All responses will be kept confidential and anonymous. Thank you for your time.
Please select from the drop down arrow.
*
Indicates required field
Name of your current Provider
*
Art Tolentino, PhD
Kelly Kimbel, MA
Lisa Hanna, MA
Mary Trukosittz, MA
Pat Beck, MS
Jennifer Shaffer, MA
Elaine Vaughn, MA
Diana Carlson, MA
Kessa Stephenson-Taylor, MA
Jeremy Bolden, MSW
Am Gering, MA
Kathy Afuola, SUDP
Daryl McInis, Intern
Name of your previous Provider
*
What is your Age?
*
Less than 13
13 to 18
19 to 25
26 to 35
36 to 50
Over 50
Your Ethnicity
*
Asian
Pacific Islander
Black/African American
American Indian/Native American
White (Not Hispanic or Latino)
Hispanic or Latino (All Races)
Unknown or Mixed
Your Sex
*
Male
Female
Other
If Other please specify:
*
EASE OF GETTING CARE:
Ability to get in to be seen in a timely fashion
*
Great
Good
Ok
Fair
Poor
I have to wait for 2 weeks
I was scheduled within 3-5 days
Convenience of Clinic's location
*
Great
Good
OK
Fair
Poor
Hours Clinic is Open
*
Great
Good
OK
Fair
Poor
Office Hours
*
Convenient for me
I like the Saturday appointment
I like the weekend graveyard time
I like the Telehealth time slot
Does not work for me
Prompt return on calls
*
Great
Good
OK
Fair
Poor
Time in waiting area
*
Website
*
Easy to find Information
User Friendly
Other
Pls. tell us how we can improve our Website
*
STAFF/PROVIDER: (Therapist, Counselor, Clinical Intern)
Listens to you
*
Yes
No
Needs Improvement
Takes enough time with you
*
Yes
No
Ok
Fair
Needs improvement
Explains what you want to know
*
Yes
No
Fair
Needs improvement
Gives good advice and resources
*
Yes
No
Fair
Needs improvement
What kind of improvement/s
*
Office Staff - Front Desk or Admin
Friendly & helpful
*
Yes
No
Fair
Poor
They answer your questions
*
Yes
No
Fair
Poor
Payment:
in-house and e-commerce
What you pay
*
Great for the price
I use my insurance
Subscription program is good
Other/s - Pls. let us know
Comment
*
Explanation of charges
*
Great
Good
OK
Fair
Poor
Collection of payment/money
*
Great
Fair
Ok
Poor
FACILITY: Our Clinic
Neat and clean building
*
Yes
No
Easy to find
*
Yes
No
Comfort and safety while waiting
*
Yes
No
Privacy/Confidentiality
*
Professional
Kept my information private & secure
I am concerned
TECHNOLOGY THAT WE USED
Telehealth (Audio & Video technology)
*
Great
OK
Fair
Poor
Other
Tele Text
*
Great
Ok
Fair
Poor
Other
If your answer is other on Telehealth, pls. let us know
*
If your answer is other on Tele Text, pls. let us know
*
Do you consider this clinic your regular source of behavioral care?
*
Yes
No
The likelihood of referring your friends and relatives to us:
*
Yes
No
Maybe
I doubt it
What do you like best about our clinic?
*
What do you like least about our clinic?
*
Suggestions for improvement
*
Thank You for completing the survey!
Submit Here
Home
Staff
Providers
Satisfaction Survey
Clinics
Lacey Clinic
Longview Clinic
Telehealth Clinic
Telehealth International
Mental Health Counseling Services
Co-occurring Disorders Treatment
>
Co-occurring Disorders Group
Mental Health
>
Outpatient Services
Group Therapy
Play Therapy
Trauma Focused Treatment
Addiction Services
DOT - SAP Services
Outpatient Services
Relapse Prevention Therapy
Gambling Services
Insurance
Accepted Insurance
Accepted EAP
Online Testing & Screening
Training
Patient Portal
Therapy Interest Form
School Services