Capeside Patient Survey
Patient Satisfaction Survey
We would like to ask you about your experience regarding your last visit to our office. Thank you for helping us continue to improve the care we provide for our patients.
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1.
Which program do you receive services with?
Capeside Psychiatry
Capeside Addiction
Both
2.
What kind of services do you receive?
Medication Management only
Therapy only
Both
3.
Overall, how satisfied were you with your last doctor’s appointment?
Extremely satisfied
Very satisfied
Somewhat satisfied
Neither satisfied nor unsatisfied
Somewhat unsatisfied
Very unsatisfied
Extremely unsatisfied
4.
Overall, how would you rate the service with the receptionists?
Excellent
Very good
Good
Fair
Poor
5.
Did your appointment with your provider start early, late, or on time?
10 or more minutes early
Less than 10 minutes early
On time
Less than 10 minutes late
10 or more minutes late
6.
How well do you feel your provider listens to your needs?
Extremely well
Very Well
Somewhat well
No so well
Not at all
7.
How well did your provider explain your treatment options?
Extremely well
Very well
Somewhat well
No so well
Not at all
8.
How would you describe your ability to contact someone over the phone?
Extremely likely
Very likely
Somewhat likely
No so likely
Not able to reach anyone by phone
9.
How likely is it that you would recommend your provider to a friend or family member?
0 (not likely at all) – 10 (extremely likely)
0 (not likely at all) – 10 (extremely likely)
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9
10
10.
Is there anything we could have done to improve your last visit?
11.
Would you like a call from one of our care specialists to address your concerns?
Yes
No
Please leave your preferred contact information.
Current Progress,
0 of 11 answered