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Outpatient Satisfaction SurveyUHSDEV2021-04-07T16:08:13-04:00

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

We’re Always Here to Help

Licensed mental health professionals are available 24 hours a day, 7 days a week to assist you or your loved one. To schedule a no-cost assessment or for more information, please call 407-370-0111.

Outpatient Satisfaction Survey

Physicians are on the medical staff of Central Florida Behavioral Hospital, but, with limited exceptions, are independent practitioners who are not employees or agents of Central Florida Behavioral Hospital. The facility shall not be liable for actions or treatments provided by physicians. Model representations of real patients are shown. TRICARE® is a registered trademark of the Department of Defense, Defense Health Agency. All rights reserved. There are risks associated with any treatment procedure and individual results may vary. Please consult the dedicated professionals within the ECT program at Central Florida Behavioral Hospital to assess if you are a candidate for ECT treatment. Our medical staff will also consult with you on the risks and benefits of ECT treatment if you are a suitable candidate.

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