Samaritan Center for Counseling and Pastoral Care

CLIENT SURVEY

We, the staff of the Samaritan Center are committed to providing the highest quality services possible to the people we serve. To assist us in this effort, we ask that you take a few minutes to complete this survey sharing your perceptions and feelings based on your experiences with the Center.

Date: Check box if you are part of the Hope for Heroes program.

Please check the appropriate boxes.

County: Williamson Travis Hays Other

Number of Counseling Sessions You Have Had:

1-5 6-10 11-20 More than 20

PART I SERVICE

For each statement, please indicate how much you agree or disagree by writing in the number that corresponds to your feeling about the statement.

NA-Not Applicable 1-Strongly Disagree 2-Disagree 3-Agree 4-Strongly Agree

1.____Initially, I easily reached the Center by telephone.

2.____Service was provided quickly after I contacted the Center.

3.____Appointment times are convenient with my schedule.

4.____The office locations are convenient.

5.____The physical environment is pleasant.

6.____The offices feel secure and confidential.

7.____When beginning couneling the amount of paperwork was manageable.

8.____My concerns and my counselor’s skills match well.

9.___Fees and collections are handled in a business like manner.

10.___Office staff are helpful in dealing with billing and insurance issues.

11.___Everyone treats me with courtesy and respect.

PART II COUNSELING

NA-Not Applicable 1-Strongly Disagree 2-Disagree 3-Agree 4-Strongly Agree

1.____My counselor has a sincere concern about my well-being.

2.____My counselor has a good understanding of my problems. PLEASE COMPLETE SIDE TWO►

3.____My counselor eased my concerns about counseling when I began.

4.____My counselor and I work well together.

5.____I am satisfied with the amount of progress I have made on my problems thus far in counseling.

6.____I am satisfied with the way the Center or my counselor has handled any emergency or crisis that has occurred

during my time in counseling.

7.____As a result of counseling, I am coping better with my problems.

8.____Others have seen a change in me.

9.____As a result of counseling, I have seen a decrease in the presenting problem symptoms which brought me to the Center.

10.___I would recommend the Center to other people.

11.___I am benefiting spiritually from this experience.

12___As a result of counseling, my relationships are improving.

13.___As a result of counseling, I am learning to communicate more effectively with family and friends.

14.___ As a result of counseling, I have learned at least one new skill to deal with my problems.

15.___ As a result of counseling, I am becoming more satisfied with myself and my life situation.

16.___If needed in the future, I would use the Center’s services again.

17.___I have made significant progress, or achieved at least one goal on my treatment plan.

PART III

1. Why did you choose the Samaritan Center for Counseling and Pastoral Care over other agencies or private counselors?

______

______

2. Please add any additional comments you would like to make.

______

______

OPTIONAL:

Name of your Counselor:______

Your Name:______

Your opinions matter to us. THANK YOU FOR YOUR HELP!!! 06/2010