EAP Customer Satisfaction Survey

from Employee Assistance of the Pacific, LLC

Mahalo for taking a few minutes to complete the nine questions in this confidential survey. It is important to us to provide you with the highest quality of care possible, and we're eager to learn from your experience at the Employee Assistance Program (EAP) in an effort to continually improve our services.

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* 1. What is the name of your Employer/Company?

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* 2. Please rate your satisfaction with obtaining EAP services.

	Exceeded expectations	Met expectations	Neutral	Did not meet expectations	Not applicable
The person I talked with on the phone was helpful in answering my questions.	The person I talked with on the phone was helpful in answering my questions. Exceeded expectations	The person I talked with on the phone was helpful in answering my questions. Met expectations	The person I talked with on the phone was helpful in answering my questions. Neutral	The person I talked with on the phone was helpful in answering my questions. Did not meet expectations	The person I talked with on the phone was helpful in answering my questions. Not applicable
I was treated in a professional, courteous manner.	I was treated in a professional, courteous manner. Exceeded expectations	I was treated in a professional, courteous manner. Met expectations	I was treated in a professional, courteous manner. Neutral	I was treated in a professional, courteous manner. Did not meet expectations	I was treated in a professional, courteous manner. Not applicable
I was able to obtain services in a reasonable amount of time.	I was able to obtain services in a reasonable amount of time. Exceeded expectations	I was able to obtain services in a reasonable amount of time. Met expectations	I was able to obtain services in a reasonable amount of time. Neutral	I was able to obtain services in a reasonable amount of time. Did not meet expectations	I was able to obtain services in a reasonable amount of time. Not applicable
I was able to obtain services in a convenient location.	I was able to obtain services in a convenient location. Exceeded expectations	I was able to obtain services in a convenient location. Met expectations	I was able to obtain services in a convenient location. Neutral	I was able to obtain services in a convenient location. Did not meet expectations	I was able to obtain services in a convenient location. Not applicable

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* 3. Please rate your satisfaction with the provider you saw.

	Exceeded expectations	Met expectations	Neutral	Did not meet expectations	Not applicable
The office was comfortable and clean.	The office was comfortable and clean. Exceeded expectations	The office was comfortable and clean. Met expectations	The office was comfortable and clean. Neutral	The office was comfortable and clean. Did not meet expectations	The office was comfortable and clean. Not applicable
The provider was attentive to me and treated me with compassion and respect.	The provider was attentive to me and treated me with compassion and respect. Exceeded expectations	The provider was attentive to me and treated me with compassion and respect. Met expectations	The provider was attentive to me and treated me with compassion and respect. Neutral	The provider was attentive to me and treated me with compassion and respect. Did not meet expectations	The provider was attentive to me and treated me with compassion and respect. Not applicable
The provider helped me resolve or cope with the challenge or issue that brought me to EAP.	The provider helped me resolve or cope with the challenge or issue that brought me to EAP. Exceeded expectations	The provider helped me resolve or cope with the challenge or issue that brought me to EAP. Met expectations	The provider helped me resolve or cope with the challenge or issue that brought me to EAP. Neutral	The provider helped me resolve or cope with the challenge or issue that brought me to EAP. Did not meet expectations	The provider helped me resolve or cope with the challenge or issue that brought me to EAP. Not applicable
I would refer a friend or family member to this provider.	I would refer a friend or family member to this provider. Exceeded expectations	I would refer a friend or family member to this provider. Met expectations	I would refer a friend or family member to this provider. Neutral	I would refer a friend or family member to this provider. Did not meet expectations	I would refer a friend or family member to this provider. Not applicable

EAP provider's name:

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* 4. EAP services with this provider ended because:

The concerns which brought me to EAP were worked out to my satisfaction.

Most of the concerns which brought me to EAP were worked out satisfactorily. There are some minor problems that I can handle.

I felt that more services would not be helpful at this time, even though significant problems remained.

The provider felt that more services would not be helpful at this time, even though significant problems remained.

I used all my allowed EAP sessions for this challenge/issue.

Other (please specify):

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* 5. My life has changed in these areas due to contacting the EAP.

	Improved	Stayed the same	Worsened	Not Applicable
Relationship with spouse/partner	Relationship with spouse/partner Improved	Relationship with spouse/partner Stayed the same	Relationship with spouse/partner Worsened	Relationship with spouse/partner Not Applicable
Relationship with children	Relationship with children Improved	Relationship with children Stayed the same	Relationship with children Worsened	Relationship with children Not Applicable
Relationship with parents or other family members	Relationship with parents or other family members Improved	Relationship with parents or other family members Stayed the same	Relationship with parents or other family members Worsened	Relationship with parents or other family members Not Applicable
Self-image (the way I think about myself)	Self-image (the way I think about myself) Improved	Self-image (the way I think about myself) Stayed the same	Self-image (the way I think about myself) Worsened	Self-image (the way I think about myself) Not Applicable
Ability to handle personal problems or stress	Ability to handle personal problems or stress Improved	Ability to handle personal problems or stress Stayed the same	Ability to handle personal problems or stress Worsened	Ability to handle personal problems or stress Not Applicable
Performance at work	Performance at work Improved	Performance at work Stayed the same	Performance at work Worsened	Performance at work Not Applicable
Overall quality of life	Overall quality of life Improved	Overall quality of life Stayed the same	Overall quality of life Worsened	Overall quality of life Not Applicable
Other (please list below)	Other (please list below) Improved	Other (please list below) Stayed the same	Other (please list below) Worsened	Other (please list below) Not Applicable

Other (please specify)

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* 6. Do you believe your EAP experience impacted your work in any of these areas?

	Large positive work impact	Some positive work impact	No work impact	Some negative work impact	Large negative work impact
Missing less work now	Missing less work now Large positive work impact	Missing less work now Some positive work impact	Missing less work now No work impact	Missing less work now Some negative work impact	Missing less work now Large negative work impact
More present when I'm at work	More present when I'm at work Large positive work impact	More present when I'm at work Some positive work impact	More present when I'm at work No work impact	More present when I'm at work Some negative work impact	More present when I'm at work Large negative work impact
More engaged with my job/company	More engaged with my job/company Large positive work impact	More engaged with my job/company Some positive work impact	More engaged with my job/company No work impact	More engaged with my job/company Some negative work impact	More engaged with my job/company Large negative work impact
More life satisfaction	More life satisfaction Large positive work impact	More life satisfaction Some positive work impact	More life satisfaction No work impact	More life satisfaction Some negative work impact	More life satisfaction Large negative work impact
Less work distress	Less work distress Large positive work impact	Less work distress Some positive work impact	Less work distress No work impact	Less work distress Some negative work impact	Less work distress Large negative work impact
Less healthcare costs	Less healthcare costs Large positive work impact	Less healthcare costs Some positive work impact	Less healthcare costs No work impact	Less healthcare costs Some negative work impact	Less healthcare costs Large negative work impact
Less drug/alcohol risks	Less drug/alcohol risks Large positive work impact	Less drug/alcohol risks Some positive work impact	Less drug/alcohol risks No work impact	Less drug/alcohol risks Some negative work impact	Less drug/alcohol risks Large negative work impact
More job satisfaction	More job satisfaction Large positive work impact	More job satisfaction Some positive work impact	More job satisfaction No work impact	More job satisfaction Some negative work impact	More job satisfaction Large negative work impact
Less emotional distress	Less emotional distress Large positive work impact	Less emotional distress Some positive work impact	Less emotional distress No work impact	Less emotional distress Some negative work impact	Less emotional distress Large negative work impact

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* 7. Rate the overall quality of care and service you received.

Exceeds expectations

Meets expectations

Neutral

Did not meet expectations

Not applicable

Comment (optional)

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* 8. Based on your experience with our EAP:

	Yes	No	Unknown
Would you use EAP again if the need arose?	Would you use EAP again if the need arose? Yes	Would you use EAP again if the need arose? No	Would you use EAP again if the need arose? Unknown
Would you recommend EAP to a co-worker?	Would you recommend EAP to a co-worker? Yes	Would you recommend EAP to a co-worker? No	Would you recommend EAP to a co-worker? Unknown
Would you recommend EAP to a family member?	Would you recommend EAP to a family member? Yes	Would you recommend EAP to a family member? No	Would you recommend EAP to a family member? Unknown

If you would like to comment on your EAP experience (positive or negative), describe below:

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* 9. Your last Follow-Up Survey Question: Over the past 30 days...

	Strongly DISAGREE	Somewhat DISAGREE	Neutral	Somewhat AGREE	Strongly AGREE
My personal problems kept me from concentrating on my work.	My personal problems kept me from concentrating on my work. Strongly DISAGREE	My personal problems kept me from concentrating on my work. Somewhat DISAGREE	My personal problems kept me from concentrating on my work. Neutral	My personal problems kept me from concentrating on my work. Somewhat AGREE	My personal problems kept me from concentrating on my work. Strongly AGREE
I am often eager to get to the work site to start the day.	I am often eager to get to the work site to start the day. Strongly DISAGREE	I am often eager to get to the work site to start the day. Somewhat DISAGREE	I am often eager to get to the work site to start the day. Neutral	I am often eager to get to the work site to start the day. Somewhat AGREE	I am often eager to get to the work site to start the day. Strongly AGREE
So far, my life seems to be going very well.	So far, my life seems to be going very well. Strongly DISAGREE	So far, my life seems to be going very well. Somewhat DISAGREE	So far, my life seems to be going very well. Neutral	So far, my life seems to be going very well. Somewhat AGREE	So far, my life seems to be going very well. Strongly AGREE
I dread going into work.	I dread going into work. Strongly DISAGREE	I dread going into work. Somewhat DISAGREE	I dread going into work. Neutral	I dread going into work. Somewhat AGREE	I dread going into work. Strongly AGREE

Over the past 30 days, the number of hours your personal concern caused you to miss work:

MAHALO from your EAP!

Employee Assistance of the Pacific, LLC
1600 Kapiolani Blvd., Suite 1610
Honolulu, HI 96814

(808) 597-8222 www.EAPacfic.com

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* 10. Address

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number