Patient Feedback
Family Guidance Centers continues its pursuit of service improvements. We are asking our current and former clients to help us understand how we are doing. This survey gives you an opportunity to evaluate our practice, services, and your experience.

Your responses are completely confidential and anonymous. The information you provide us will in no way effect your current treatment. We are primarily concerned with our efforts to serve you in the best way possible. By taking this survey, you agree to the anonymous/private use of your responses.

*****If you have never been a patient of Family Guidance Centers, please do not complete this survey.*****
Sign in to Google to save your progress. Learn more
How did you hear about us? *
Therapist Name *
How easy was it to make your first appointment? *
Very Difficult
Very Easy
What location are you seen in? *
How would you rate the office cleanliness?
Please skip if your visit was telehealth.
Very Dirty
Very Clean
Clear selection
How would you rate the office comfort?
Please skip if your visit was telehealth.
Very Uncomfortable
Very Comfortable
Clear selection
How is your experience checking in when you arrive to your appointments? *
Terrible/Very Difficult
Great/Very Easy
Was there a receptionist at your office location? *
How has your experience been with the administrative staff? *
Very Unhelpful
Very Helpful
Please comment on your experience with the administrative staff.
We welcome your supportive statements and discussion of problems you encountered.
How would you rate your therapist? *
Very Unhelpful
Very Helpful
Was your therapist respectful? *
Very Disrespectful
Very Respectful
How easy it is to reach your therapist to schedule appointments? *
Very Difficult
Very Easy
Did you receive reminders for your appointments? *
Please comment on your therapy experience.
We welcome your supportive statements and discussion of problems you encountered.
Is there anything you'd like your therapist to know that you were not comfortable saying directly to them? *
If your visit was Telehealth, please rate your sign in experience.
Very Hard
Very Easy
Clear selection
If your visit was Telehealth, how would you rate the effectiveness of your virtual session?
Very Ineffective
Very Effective
Clear selection
Have you visited our website? *
How easy it is to navigate and find information you need on our website?
Very Difficult
Very Easy
Clear selection
Please comment on non-therapy problems or make supportive statements about your overall experience with Family Guidance Centers.
Please rate your overall experience at Family Guidance Centers. *
Terrible
Great
Would you recommend Family Guidance Centers to others? *
Gender *
Patient Age Range *
Patient Name
This is completely optional, if you want your response to have your name on it. If you do not include your name, this survey is completely anonymous.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Family Guidance Centers. Report Abuse
Google Forms