Client Satisfaction Comment Form

CLIENT SATISFACTION COMMENT FORM

We sincerely hope that you found your appointment with FASAP to be helpful. We are continuously trying to improve the quality of our program so that we may better serve you. Please take a moment to complete this client satisfaction form. Your answers will remain completely confidential.

Office Location Visited:	550 Bldg., Rm 507 (East Baltimore Campus)
	4 East 33rd St. (Homewood Campus)
	Other

Strongly
Disagree Disagree Neutral Agree Strongly
Agree

1. The administrative staff was available and responsive
when I contacted FASAP to acquire information and/or
arrange an appointment.

2. Given my work schedule, convenient appointment
times were available.

3. My appointment was scheduled in a timely manner.

4. The location of the office I visited was convenient.

5. The office I visited was comfortable and attractive.

6. The administrative staff was professional and friendly.

7. The clinician was professional and informative.

8. The clinician helped me to feel comfortable during the session.

9. My visit with the clinician was useful in that we were
able to address some of my primary concerns.

10. I felt that the allotted time was sufficient to address
my concerns.

11. I would recommend FASAP to a co-worker or relative
who was experiencing problems.

12. If I were to seek help again, I would return to FASAP.

Additional Comments or Suggestions:

Thank you for taking the time to complete this card

		Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
1.	The administrative staff was available and responsive when I contacted FASAP to acquire information and/or arrange an appointment.
2.	Given my work schedule, convenient appointment times were available.
3.	My appointment was scheduled in a timely manner.
4.	The location of the office I visited was convenient.
5.	The office I visited was comfortable and attractive.
6.	The administrative staff was professional and friendly.
7.	The clinician was professional and informative.
8.	The clinician helped me to feel comfortable during the session.
9.	My visit with the clinician was useful in that we were able to address some of my primary concerns.
10.	I felt that the allotted time was sufficient to address my concerns.
11.	I would recommend FASAP to a co-worker or relative who was experiencing problems.
12.	If I were to seek help again, I would return to FASAP.