Group Health Behavioral Health Services Patient Satisfaction Survey
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3Behavioral Health Services
Patient Satisfaction Survey
Please answer the following questions by filling in the bubble with a blue or black pen or pencil.
X
PROPER MARK
IMPROPER MARKS
Visits with Your Practitioner
Thinking about the visit specified in the letter, please indicate the type of practitioner you saw:
1. Please pick one:
Mental health therapist or counselor (Master’s degree)
Chemical Dependency (alcohol or drug) counselor
Psychiatrist (MD/DO)
Nurse Practitioner (ARNP)
Psychologist (PhD)
Don’t know
Thinking about practitioner whom you saw on the visit indicated in the letter, how would you rate:
Very
Not
Excellent
Good
Good
Fair
Poor
Applicable
2. How prepared this practitioner was for your visits.....................
3. Attention this practitioner paid to what you had to say..............
4. How well this practitioner understood your concerns................
5. Thoroughness and competence of this practitioner ..................
6. Length of time between visits with this practitioner (if you’ve
only seen this practitioner once, mark Not Applicable) ......
Continuing to think about the visit(s) you’ve had with the practitioner on the date identified in the letter, please rate
your agreement with the following statements:
Strongly
Strongly
Not
Agree
Agree
Neutral Disagree
Disagree
Applicable
7. This practitioner focused on achieving the goals for my
counseling or treatment .............................................................
8. This practitioner gave me as much information as I wanted
about what I could do to manage my condition .........................
9. This practitioner and other behavioral health practitioners,
if any, worked as a team in coordinating my care .....................
10. This practitioner and my primary medical doctor,
if involved, worked as a team in coordinating my care..............
11. How likely would you be to recommend this practitioner to a friend or family member?
Would definitely NOT recommend
Would definitely recommend
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12/2006
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