OPT Client Satisfaction Survey

We would like to know how you feel about the services you are receiving through our Outpatient Services program. Please take a few minutes to answer the following questions. Your responses will assist us in making improvements to our services to ensure the needs of each of our clients are met. You responses are anonymous and will be kept confidential.

Your opinion matters! Thank you for your time.

Name of your therapist *Jami Lyn Duane-Brady Jami Lyn Duane-BradyAmanda TuttleMichael Van NessTynesha LomaxMonica CwynarCurtis WilliamsKimberly WashingtonAmy SzymanskiTania Kannadan, MDMarie Engberg, CRNP

Number of months/years receiving outpatient services: *

Age of Client:

Client Gender Identity:FemaleFemaleMaleNon-Binary/Non-ConformingPrefer not to answer

Race (Check all that apply)Black/African American Black/African AmericanWhite/CaucasianHispanicAsianNative AmericanIndigenous AlaskanHawaiian/Pacific Islander

Services received (Check all that apply): *Individual Therapy Individual TherapyFamily TherapyTBRIPCITReparative Relational Therapy (RRT) (Formerly known as TSV)Co-parentingPsychiatric/Med. Management

Looking back to your first contact with TRAC…

Please rate your responses on a scale of 1 to 5 – With 1 being Poor/Never Agree and 5 being Excellent/Very Strongly Agree. 0 will be considered Not Applicable (N/A)

My initial call for treatment was returned quickly

Selected Value: 5

I was treated with respect

Selected Value: 5

My appointment was scheduled in a timely manner

Selected Value: 5

Your time in the waiting room…

Please rate your responses on a scale of 1 to 5 – With 1 being Poor/Never Agree and 5 being Excellent/Very Strongly Agree. 0 will be considered Not Applicable (N/A)

The front desk office staff are friendly

Selected Value: 5

The Waiting Room is neat and clean

Selected Value: 5

The time I spend waiting before my appointment is appropriate (in person or via zoom)

Selected Value: 5

Therapy rooms are neat and clean

Selected Value: 5

My information is kept confidential

Selected Value: 5

Your time in therapy…

Please rate your responses on a scale of 1 to 5 – With 1 being Poor/Never Agree and 5 being Excellent/Very Strongly Agree. 0 will be considered Not Applicable (N/A)

My therapist seems prepared for our session

Selected Value: 5

My therapist listens to my concerns

Selected Value: 5

My therapist empowers me to make changes

Selected Value: 5

My therapist provides feedback and suggestions that are positive and helpful

Selected Value: 5

My therapist lets me know the progress I am making

Selected Value: 5

I participated in the development of my treatment plan

Selected Value: 5

My therapist periodically reviews my treatment plan with me

Selected Value: 5

Overall Impression…

Please rate your responses on a scale of 1 to 5 – With 1 being Poor/Never Agree and 5 being Excellent/Very Strongly Agree. 0 will be considered Not Applicable (N/A)

I feel I am making progress in reaching my treatment goals

Selected Value: 5

I feel better about things since beginning treatment

Selected Value: 5

I would recommend TRAC’s Outpatient Therapy to others

Selected Value: 5

Additional Comments…

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