Customer Satisfaction Survey Template
1.
On a scale of 0 to 10,
How likely is it that you would recommend Urban Institute of Mental Health to a friend or colleague?
0 for Not at all likely, 10 for Extremely likely
Not at all likely
Extremely likely
0
1
2
3
4
5
6
7
8
9
10
2.
Overall, how satisfied or dissatisfied are you with Urban Institute of Mental Health?
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
3.
Which of the following words would you use to describe our services? Select all that apply.
Reliable
High quality
Useful
Unique
Effective
Overpriced
Impractical
Ineffective
Poor quality
Unreliable
4.
How well do our services meet your needs?
Extremely well
Very well
Somewhat well
Not so well
Not at all well
5.
How would you rate the quality of the service?
Very high quality
High quality
Neither high nor low quality
Low quality
Very low quality
6.
How responsive have we been to your questions or concerns about our services?
Extremely responsive
Very responsive
Somewhat responsive
Not so responsive
Not at all responsive
Not applicable
7.
Do you feel that your therapist has been effective in meeting your needs?
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
8.
Is your therapist warm, empathetic, non-judgemental, and authentic?
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
9.
Is your therapist professional and timely?
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
10.
Please add any extra feedback, comments, or thoughts here:
Current Progress,
0 of 10 answered