patient perception survey: Jerry Semivan
 
  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 therapist listen to you and address your questions?
5Did you think your therapist was helpful to you?
6Was your therapist sensitive to your needs?
p=poorf=fairg=goodvg=very goode=excellent
  pfgvge
7Rate your level of satisfaction with the assistance you received from your therapist.
8Rate how well the services you received from your therapist helped improve your ability to cope with your problem(s).
9Overall, how would you rate your satisfaction with the services you received from your therapist?
  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 practice / therapists?
12For verification purposes, please enter the patient age to right:
13Additional comments about your therapist: Please be honest and feel free to express your own opinion (optional).

Characters remaining: 2000
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