Home
About
Meet Our Team
Testimonials
FAQ's on Therapy
Careers
Contact Us
Services
TeleMental Health
Individual Counseling
Marriage/Couples Counseling
Child/Adolescent Counseling
Family Counseling
ADHD Coaching
Life Coaching/Consultation
Hypnotherapy
Health + Wellness Coaching
Groups
>
Virtual Support Group
ADHD Parent Support Group
LEGO Group for Kids
Postpartum Depression/Anxiety
Women of Faith
Business Trainings
Speaking Engagements
Workshops
Dealing With Everyday Stress: A Guide to Daily Stress Reduction
Taking Care of Ourselves: Stress Reduction Workshop for Moms
How to Sleep When Your Mind Won't Shut Off
Creating a Behavioral Reward System That Works
Coping with Grief Over the Holidays
Live Mindfully: Healthy Mind = Healthy Body
Undress Your Stress: Fun Ways to De-Stress Workshop!
Rates
Events
Screening Day
Freebies
Blog
Downloadable Tools
Newsletter
Screening Tools
Home
About
Meet Our Team
Testimonials
FAQ's on Therapy
Careers
Contact Us
Services
TeleMental Health
Individual Counseling
Marriage/Couples Counseling
Child/Adolescent Counseling
Family Counseling
ADHD Coaching
Life Coaching/Consultation
Hypnotherapy
Health + Wellness Coaching
Groups
>
Virtual Support Group
ADHD Parent Support Group
LEGO Group for Kids
Postpartum Depression/Anxiety
Women of Faith
Business Trainings
Speaking Engagements
Workshops
Dealing With Everyday Stress: A Guide to Daily Stress Reduction
Taking Care of Ourselves: Stress Reduction Workshop for Moms
How to Sleep When Your Mind Won't Shut Off
Creating a Behavioral Reward System That Works
Coping with Grief Over the Holidays
Live Mindfully: Healthy Mind = Healthy Body
Undress Your Stress: Fun Ways to De-Stress Workshop!
Rates
Events
Screening Day
Freebies
Blog
Downloadable Tools
Newsletter
Screening Tools
Patient Satisfaction Survey
*
Indicates required field
How likely is it that you would recommend Center for Personal Wellness to a friend or family member?
*
0 (Not likely at all)
1
2
3
4
5
6
7
8
9
10 (Extremely Likely)
Overall, how satisifed or dissatisifed were you with your visits to our office?
*
Very Satisfied
Satisfied
Neutral
Unsatisfied
Very Unsatisfied
How easy or diffiucult was it to schedule your first appointment with us?
*
Very easy
Somewhat easy
Neither easy or difficult
Somewhat difficult
Very difficult
How convenient did you find the online portal paperwork?
*
Extremely convenient
Very convenient
Somewhat convenient
No so convenient
Not at all convenient
Overall, how helpful did you find the between session support that was included (text messages, emails, etc)?
*
Extremely helpful
Very helpful
Somewhat helpful
Not so helpful
Not at all helpful
How confortable was the lobby, waiting area and office?
*
Extremely comfortable
Very comfortable
Somewhat comfortable
Not so comfortable
Not at all comfortable
Overall, how would you rate the care you received from your provider?
*
Excellent
Very good
Good
Fair
Poor
How well did your provider listen to your needs?
*
Extremely well
Very well
Somewhat well
Not so well
Not at all well
How satisfied or dissatisfied were you with the amount of time the provider spent with you addressing your needs?
*
Extremely satisfied
Very satisfied
Neither satisfied or disatisfied
Somewhat dissatisfied
Very dissatisfied
Is there anything we could have done to improve?
*
Submit