patient perception survey: Karen Folkwein
 
  YesNo
1Were you involved in setting goals for your treatment?
2Were you asked to score on a "1-5" scale how you were doing at the start of treatment on the goals you identified?
3Were you asked to score your progress using the "1-5" scale while you were in treatment?
4Did your nurse listen to you and address your questions about medication?
5Did your nurse discuss treatment options with you?
(Medication, herbal, natural treatments, individual / family therapy)
6On an average, how many minutes would you say you have to wait to see the nurse?
p=poorf=fairg=goodvg=very goode=excellent
  pfgvge
7Rate your level of satisfaction with the assistance you received from your nurse.
8Rate how well the services you received from your nurse helped improve your ability to cope with your problem(s).
9Overall, how would you rate your satisfaction with the services you received from your nurse?
  YesNo
10Do you feel like you've made progress towards your treatment goals?
11If you had a friend who needed help, would you recommend our nurses?
12For verification purposes, please enter the patient age to right:
13Additional comments about your nurse: Please be honest and feel free to express your own opinion (optional)

Characters remaining: 2000
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