Client Satisfaction Survey

You or a member(s) of your family have recently completed a course of treatment at Birmingham Maple Clinic. In order to help us monitor and improve the quality of service we provide, we would appreciate it if you would take a few minutes to respond to the following questions. Your responses will be entirely confidential.

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1. Did you receive prompt attention when you first contacted us?	1. Did you receive prompt attention when you first contacted us? 1	1. Did you receive prompt attention when you first contacted us? 2	1. Did you receive prompt attention when you first contacted us? 3	1. Did you receive prompt attention when you first contacted us? 4	1. Did you receive prompt attention when you first contacted us? 5
2. Were your questions handled in a courteous manner?	2. Were your questions handled in a courteous manner? 1	2. Were your questions handled in a courteous manner? 2	2. Were your questions handled in a courteous manner? 3	2. Were your questions handled in a courteous manner? 4	2. Were your questions handled in a courteous manner? 5
3. Was your first appointment scheduled within a reasonable time?	3. Was your first appointment scheduled within a reasonable time? 1	3. Was your first appointment scheduled within a reasonable time? 2	3. Was your first appointment scheduled within a reasonable time? 3	3. Was your first appointment scheduled within a reasonable time? 4	3. Was your first appointment scheduled within a reasonable time? 5

1. Did you receive prompt attention when you first contacted us?

1. Did you receive prompt attention when you first contacted us? 1

1. Did you receive prompt attention when you first contacted us? 2

1. Did you receive prompt attention when you first contacted us? 3

1. Did you receive prompt attention when you first contacted us? 4

1. Did you receive prompt attention when you first contacted us? 5

2. Were your questions handled in a courteous manner?

2. Were your questions handled in a courteous manner? 1

2. Were your questions handled in a courteous manner? 2

2. Were your questions handled in a courteous manner? 3

2. Were your questions handled in a courteous manner? 4

2. Were your questions handled in a courteous manner? 5

3. Was your first appointment scheduled within a reasonable time?

3. Was your first appointment scheduled within a reasonable time? 1

3. Was your first appointment scheduled within a reasonable time? 2

3. Was your first appointment scheduled within a reasonable time? 3

3. Was your first appointment scheduled within a reasonable time? 4

3. Was your first appointment scheduled within a reasonable time? 5

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1. Were you satisfied with our office's physical set-up?	1. Were you satisfied with our office's physical set-up? 1	1. Were you satisfied with our office's physical set-up? 2	1. Were you satisfied with our office's physical set-up? 3	1. Were you satisfied with our office's physical set-up? 4	1. Were you satisfied with our office's physical set-up? 5
2. Was the setting helpful in promoting: A sense of confidentiality?	2. Was the setting helpful in promoting: A sense of confidentiality? 1	2. Was the setting helpful in promoting: A sense of confidentiality? 2	2. Was the setting helpful in promoting: A sense of confidentiality? 3	2. Was the setting helpful in promoting: A sense of confidentiality? 4	2. Was the setting helpful in promoting: A sense of confidentiality? 5
3. Comfort and security?	3. Comfort and security? 1	3. Comfort and security? 2	3. Comfort and security? 3	3. Comfort and security? 4	3. Comfort and security? 5

1. Were you satisfied with our office's physical set-up?

1. Were you satisfied with our office's physical set-up? 1

1. Were you satisfied with our office's physical set-up? 2

1. Were you satisfied with our office's physical set-up? 3

1. Were you satisfied with our office's physical set-up? 4

1. Were you satisfied with our office's physical set-up? 5

2. Was the setting helpful in promoting: A sense of confidentiality?

2. Was the setting helpful in promoting: A sense of confidentiality? 1

2. Was the setting helpful in promoting: A sense of confidentiality? 2

2. Was the setting helpful in promoting: A sense of confidentiality? 3

2. Was the setting helpful in promoting: A sense of confidentiality? 4

2. Was the setting helpful in promoting: A sense of confidentiality? 5

3. Comfort and security?

3. Comfort and security? 1

3. Comfort and security? 2

3. Comfort and security? 3

3. Comfort and security? 4

3. Comfort and security? 5

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1. If you needed to interact with our business office, were you treated with respect and good customer service?	1. If you needed to interact with our business office, were you treated with respect and good customer service? 1	1. If you needed to interact with our business office, were you treated with respect and good customer service? 2	1. If you needed to interact with our business office, were you treated with respect and good customer service? 3	1. If you needed to interact with our business office, were you treated with respect and good customer service? 4	1. If you needed to interact with our business office, were you treated with respect and good customer service? 5
2. Were your messages returned in a timely fashion?	2. Were your messages returned in a timely fashion? 1	2. Were your messages returned in a timely fashion? 2	2. Were your messages returned in a timely fashion? 3	2. Were your messages returned in a timely fashion? 4	2. Were your messages returned in a timely fashion? 5
3. Were your bills and other financial information clear and easy to understand?	3. Were your bills and other financial information clear and easy to understand? 1	3. Were your bills and other financial information clear and easy to understand? 2	3. Were your bills and other financial information clear and easy to understand? 3	3. Were your bills and other financial information clear and easy to understand? 4	3. Were your bills and other financial information clear and easy to understand? 5
4. Were requests for information about your bill handled to your satisfaction by our business office?	4. Were requests for information about your bill handled to your satisfaction by our business office? 1	4. Were requests for information about your bill handled to your satisfaction by our business office? 2	4. Were requests for information about your bill handled to your satisfaction by our business office? 3	4. Were requests for information about your bill handled to your satisfaction by our business office? 4	4. Were requests for information about your bill handled to your satisfaction by our business office? 5

1. If you needed to interact with our business office, were you treated with respect and good customer service?

1. If you needed to interact with our business office, were you treated with respect and good customer service? 1

1. If you needed to interact with our business office, were you treated with respect and good customer service? 2

1. If you needed to interact with our business office, were you treated with respect and good customer service? 3

1. If you needed to interact with our business office, were you treated with respect and good customer service? 4

1. If you needed to interact with our business office, were you treated with respect and good customer service? 5

2. Were your messages returned in a timely fashion?

2. Were your messages returned in a timely fashion? 1

2. Were your messages returned in a timely fashion? 2

2. Were your messages returned in a timely fashion? 3

2. Were your messages returned in a timely fashion? 4

2. Were your messages returned in a timely fashion? 5

3. Were your bills and other financial information clear and easy to understand?

3. Were your bills and other financial information clear and easy to understand? 1

3. Were your bills and other financial information clear and easy to understand? 2

3. Were your bills and other financial information clear and easy to understand? 3

3. Were your bills and other financial information clear and easy to understand? 4

3. Were your bills and other financial information clear and easy to understand? 5

4. Were requests for information about your bill handled to your satisfaction by our business office?

4. Were requests for information about your bill handled to your satisfaction by our business office? 1

4. Were requests for information about your bill handled to your satisfaction by our business office? 2

4. Were requests for information about your bill handled to your satisfaction by our business office? 3

4. Were requests for information about your bill handled to your satisfaction by our business office? 4

4. Were requests for information about your bill handled to your satisfaction by our business office? 5

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1. Do you feel you were treated with respect by your therapist?	1. Do you feel you were treated with respect by your therapist? 1	1. Do you feel you were treated with respect by your therapist? 2	1. Do you feel you were treated with respect by your therapist? 3	1. Do you feel you were treated with respect by your therapist? 4	1. Do you feel you were treated with respect by your therapist? 5
2. Do you feel that the information you gave about yourself was handled in a confidential manner?	2. Do you feel that the information you gave about yourself was handled in a confidential manner? 1	2. Do you feel that the information you gave about yourself was handled in a confidential manner? 2	2. Do you feel that the information you gave about yourself was handled in a confidential manner? 3	2. Do you feel that the information you gave about yourself was handled in a confidential manner? 4	2. Do you feel that the information you gave about yourself was handled in a confidential manner? 5
3. Did you talk with your therapist to determine issues you will be working on in therapy?	3. Did you talk with your therapist to determine issues you will be working on in therapy? 1	3. Did you talk with your therapist to determine issues you will be working on in therapy? 2	3. Did you talk with your therapist to determine issues you will be working on in therapy? 3	3. Did you talk with your therapist to determine issues you will be working on in therapy? 4	3. Did you talk with your therapist to determine issues you will be working on in therapy? 5
4. Were the goals for your therapy clear?	4. Were the goals for your therapy clear? 1	4. Were the goals for your therapy clear? 2	4. Were the goals for your therapy clear? 3	4. Were the goals for your therapy clear? 4	4. Were the goals for your therapy clear? 5
5. Were you kept informed about your progress?	5. Were you kept informed about your progress? 1	5. Were you kept informed about your progress? 2	5. Were you kept informed about your progress? 3	5. Were you kept informed about your progress? 4	5. Were you kept informed about your progress? 5
6. Were you able to ask your therapist questions about your treatment?	6. Were you able to ask your therapist questions about your treatment? 1	6. Were you able to ask your therapist questions about your treatment? 2	6. Were you able to ask your therapist questions about your treatment? 3	6. Were you able to ask your therapist questions about your treatment? 4	6. Were you able to ask your therapist questions about your treatment? 5
7. Was treatment closure handled in a supportive manner?	7. Was treatment closure handled in a supportive manner? 1	7. Was treatment closure handled in a supportive manner? 2	7. Was treatment closure handled in a supportive manner? 3	7. Was treatment closure handled in a supportive manner? 4	7. Was treatment closure handled in a supportive manner? 5
8. Did you find the treatment helpful?	8. Did you find the treatment helpful? 1	8. Did you find the treatment helpful? 2	8. Did you find the treatment helpful? 3	8. Did you find the treatment helpful? 4	8. Did you find the treatment helpful? 5

1. Do you feel you were treated with respect by your therapist?

1. Do you feel you were treated with respect by your therapist? 1

1. Do you feel you were treated with respect by your therapist? 2

1. Do you feel you were treated with respect by your therapist? 3

1. Do you feel you were treated with respect by your therapist? 4

1. Do you feel you were treated with respect by your therapist? 5

2. Do you feel that the information you gave about yourself was handled in a confidential manner?

2. Do you feel that the information you gave about yourself was handled in a confidential manner? 1

2. Do you feel that the information you gave about yourself was handled in a confidential manner? 2

2. Do you feel that the information you gave about yourself was handled in a confidential manner? 3

2. Do you feel that the information you gave about yourself was handled in a confidential manner? 4

2. Do you feel that the information you gave about yourself was handled in a confidential manner? 5

3. Did you talk with your therapist to determine issues you will be working on in therapy?

3. Did you talk with your therapist to determine issues you will be working on in therapy? 1

3. Did you talk with your therapist to determine issues you will be working on in therapy? 2

3. Did you talk with your therapist to determine issues you will be working on in therapy? 3

3. Did you talk with your therapist to determine issues you will be working on in therapy? 4

3. Did you talk with your therapist to determine issues you will be working on in therapy? 5

4. Were the goals for your therapy clear?

4. Were the goals for your therapy clear? 1

4. Were the goals for your therapy clear? 2

4. Were the goals for your therapy clear? 3

4. Were the goals for your therapy clear? 4

4. Were the goals for your therapy clear? 5

5. Were you kept informed about your progress?

5. Were you kept informed about your progress? 1

5. Were you kept informed about your progress? 2

5. Were you kept informed about your progress? 3

5. Were you kept informed about your progress? 4

5. Were you kept informed about your progress? 5

6. Were you able to ask your therapist questions about your treatment?

6. Were you able to ask your therapist questions about your treatment? 1

6. Were you able to ask your therapist questions about your treatment? 2

6. Were you able to ask your therapist questions about your treatment? 3

6. Were you able to ask your therapist questions about your treatment? 4

6. Were you able to ask your therapist questions about your treatment? 5

7. Was treatment closure handled in a supportive manner?

7. Was treatment closure handled in a supportive manner? 1

7. Was treatment closure handled in a supportive manner? 2

7. Was treatment closure handled in a supportive manner? 3

7. Was treatment closure handled in a supportive manner? 4

7. Was treatment closure handled in a supportive manner? 5

8. Did you find the treatment helpful?

8. Did you find the treatment helpful? 1

8. Did you find the treatment helpful? 2

8. Did you find the treatment helpful? 3

8. Did you find the treatment helpful? 4

8. Did you find the treatment helpful? 5

Question Title

* Summary:

	Yes	No
1. Was Birmingham Maple Clinic able to meet your needs?	1. Was Birmingham Maple Clinic able to meet your needs? Yes	1. Was Birmingham Maple Clinic able to meet your needs? No
2. Would you return in the future if you needed to?	2. Would you return in the future if you needed to? Yes	2. Would you return in the future if you needed to? No
3. Would you recommend Birmingham Maple Clinic to a family member, friend or colleague?	3. Would you recommend Birmingham Maple Clinic to a family member, friend or colleague? Yes	3. Would you recommend Birmingham Maple Clinic to a family member, friend or colleague? No

Client Satisfaction Survey

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* About your first contact with us:

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* About our facility:

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* About our business office management:

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* About the service you received from your therapist:

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* Summary:

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* Please list any factors which may have interfered with your receiving services:

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* Please add any additional comments you may have?

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* How did you learn about Birmingham Maple Clinic?

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* Gender

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* Age Group:

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* Race/Ethnicity: