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Toggle Navigation
Programs & Services
Inpatient
Affective Disorder
Dual Diagnosis
Psychiatric Intensive Care
Outpatient
Intensive Outpatient Program
Partial Hospitalization Program
Virtual Adolescent IOP
Child Programs
Adolescent Programs
General Adult
Mature Adult
Electroconvulsive Therapy (ECT)
About Us
Welcome from our CEO
Leadership Team
Medical Staff
Licensing & Accreditation
Partnerships
Virtual Tour
Resources
Admissions
FAQ
Insurance
Make a Referral
Outpatient Forms
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Contact Us
Bill Pay
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407-370-0111
Outpatient Satisfaction Survey
uhs@CFBH
2024-06-10T14:38:04+00:00
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Outpatient Satisfaction Survey
Outpatient Satisfaction Survey
Date Completed
*
MM slash DD slash YYYY
Patient Name
*
First
Last
Completed By
Patient
Parent/Guardian
Other
Your care and comfort is important to us and we continually want to improve our services. You can help us by taking a moment and completing this survey. Please place select your answer and feel free to add comments or suggestions.
1. I was encouraged to help myself and ask others to help me.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
2. I was informed of my rights.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
3. I felt safe while I was here.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
4. The environment was clean and comfortable.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
5. Staff were sensitive to my language, culture, and spiritual needs.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
6. My therapist responded to and addressed my needs.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
7. The therapy groups were helpful to me.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
8. I had input into my treatment plan goals.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
9. I was treated with dignity and respect.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
10. My treatment goals and needs were met.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
11. I feel better now than when I was admitted.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
12. The information and education provided by the program addressed my needs.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
13. I understand the importance of following my discharge plan.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
14. Overall I was satisfied with my treatment.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
15. On a scale of 0-10, how likely would you be to recommend our facility to a friend or family member?
*
0 - Not Likely
1
2
3
4
5
6
7
8
9
10 - Very Likely
Is there a staff member whom you would like to see congratulated or thanked for the care he or she provided?
Do you have a comment or suggestion on how the facility can improve patient safety or the treatment it provides?
Program Type
PHP-5 day
Day IOP-3 day
Evening IOP
Adolescent IOP
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