Stakeholder Experience Survey
Please complete the following survey to provide us with information so that we may continue to improve our life-changing services to your patients. Thank you very much for your assistance.
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Form completed by: *
Services referred:
Please select the response that best corresponds to the statement. *
Excellent
Good
Fair
Poor
Not Applicable
Promptness of admission following my patient’s referral to the Center.
Promptness of addressing issues or requests directed to the Center.
Center staff accessibility and availability.
Appropriate level of intensity, frequency, and duration of service.
Treatment plan appropriate to the patient’s diagnosis.
Appropriate scope of discharge planning and recommendations.
Patient progress reports received timely and with appropriate content.
Satisfaction with the patient outcomes.
Accuracy of program information as presented by staff, print, website.
Overall impressions of the Center.
Please provide any additional information regarding the Center's programs that you feel would be beneficial.
If you would like someone to contact you regarding the services we offer, please provide your contact information below.
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