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* 1. How long have you been coming to Insight?

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* 2. Do you feel the presenting problem that brought you to Insight is improved?

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* 3. Do you feel you have an influence on the content of the session?

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* 4. Do you feel your clinician and/or case manager is helpful?

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* 5. Do you feel heard, understood, and respected?

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* 6. Do you feel your clinician and/or case manager is a good fit for you?

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* 7. Do you feel your clinician and/or case manager actively listens and is invested in your care?

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* 8. Do you feel your counseling office was conducive to doing good therapeutic work and was free from distractions.

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* 9. Would you recommend this agency, clinician, and/or case manager to others?

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* 10. If you needed help in the future, would you feel comfortable calling this agency?

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* 11. Do you feel the administrative staff at Insight is respectful and courteous to you?

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* 12. Do you feel the the receptionist was warm and inviting?

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* 13. If applicable, did the receptionist meet any specialized needs you had upon check in?

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* 14. If you have had contact with the billing department, were they friendly and helpful.

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* 15. When you made your first appointment at Insight, was the person who handled your scheduling friendly and helpful?

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* 16. Do you feel the services at Insight are affordable?

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* 17. When scheduling your appointment, were you made aware of the ESTIMATED cost of your insurance including self pay amounts, copays, and deductibles?

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* 18. Do you feel the facilities at Insight are accessible, including walkways and entryways?

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* 19. Do you find the locations and hours of operation at Insight meet your needs?

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* 20. Were you able to get an appointment and receive communication from Insight within a reasonable timeframe?

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* 21. If you require assistance in paperwork, or English is not your first language, did Insight sensitively provide an alternative for you?

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* 22. If you use Telehealth for appointments, how would you rate the ease of use?

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i We adjusted the number you entered based on the slider’s scale.

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* 23. Do you feel the waiting areas of Insight were inviting and welcoming?

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* 24. How long do you wait in the waiting room, once your session time starts?

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* 25. If you have Ohio Medicaid, are you aware that Insight offers case management services?

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* 26. Has your clinician and/or case manager ever recommended an outside provider or resource to enhance your care, such as a psychiatrist or nurse practitioner for medication management, a primary care provider, a group, or community resource?

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* 27. Any addtional feedback or comments on Insight are welcome.

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