Healing Wounds Healthcare (HWHC) Client Care Survey

Dear HWHC Client,

From first contact to discharge, our goal is to provide you with the most respectful, responsive and empathetic care possible. To help us achieve this goal, we kindly ask for a few moments of your time to complete our Client Care Survey. Your comments are invaluable and will directly contribute to making improvements that matter most to current and future clients.

The survey should take no more than 5 minutes to complete. Be rest assured that all responses will be kept confidential and used solely for the purpose of improving our services. Your participation is greatly appreciated, and we thank you in advance for your time and thoughts.

Warm regards, Cherie Burgess, LMHC

Initial Contact Questions

How satisfied were you with your initial contact with our organization? For instance, were you treated kindly and with respect? Were your concerns addressed? Did you receive timely feedback? Please select an answer with 1 being completely dissatisfied, 2 being somewhat satisfied, 3 being mostly satisfied and 4 being very satisfied.

1 2 3 4

Is there something we did particularly well with our first contact with you?

Is there something we could improve on with our first contact with you?

About Your Therapist/Coach Questions

How satisfied were you (or are you) with your therapist/coach? Please select an answer with 1 being completely dissatisfied, 2 being somewhat satisfied, 3 being mostly satisfied and 4 being very satisfied.

1 2 3 4

What do you like most about your therapist/coach?

What is one thing your therapist/coach could improve on to provide you with the best service possible?

Follow Up Questions

How likely are you to recommend us to your friends and family? Please select an answer with 1 being not at all, 2 being somewhat likely, 3 being most likely and 4 being definitely likely.

1 2 3 4

Is there anything else you would like us to know that would help with overall client care?

About You

Age

12 to 17 18 to 21 21 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 and over

Contact Information

If you would like us to follow up with you to discuss your experience, please fill out your contact information below.

Yes, please follow up with me to discuss my experience

Client name

Phone number

Email address

Additional comments

Formatted text

Your information will be encrypted.

Healing Wounds Healthcare (HWHC) Client Care Survey

Healing Wounds Healthcare, LLC

Initial Contact Questions

About Your Therapist/Coach Questions

Follow Up Questions

About You

Contact Information

Healing Wounds Healthcare, LLC

Cherie Burgess, LMHC

Owner of Healing Wounds Healthcare