Client Survey

Page One
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2. What Location did you see this provider at?
3. Please rate your provider in the following areas.
3. Please rate your provider in the following areas.Poor
0
1234Excellent
5
Overall rating
Courtesy and professionalism
Understanding of your issue/situation
Effectiveness in treating your issue/situation
What are the chances you would refer this provider to a family member or friend?
4. Did you schedule a follow up appointment? If no, why not?
6. Please rate the following regarding the clinic.
6. Please rate the following regarding the clinic.Poor
0
1234Excellent
5
Ease of scheduling of your initial appointment
Atmosphere of the office
The receptionist on staff (if applicable)

This information will remain confidential and anonymous.

If you would like to contact us regarding this survey or provide additional feedback, please contact Molly Kehr, MA, LMFT, Director of Business Development directly at 651-286-8591.