2021 Patient Survey

This survey will be used for provider and agency feedback. No individual patient names are needed to complete the survey.

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* 1. Please provide the name of your provider.

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* 2. I feel supported and understood by my provider.

Agree

Disagree

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* 3. I am able to use what I learn here to make improvements in my life.

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* 4. Is there anything that would be more helpful about your treatment?

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* 5. Do you feel your provider is a good fit for you? What works well and what improvements could be made?

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* 6. Is the office clean, comfortable, and enjoyable? Are there improvements you would like to see in the treatment setting?

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* 7. Any other comments you would like to add?