Individual Satisfaction Survey

Still Waters Professional Counseling Services, Inc.
  • Survey Explanation

    In order to better to serve you (or the individual you represent) better, we would love your input. We will use this survey data to improve our services and customer service.
  • Survey Instructions

    Please honestly answer all of the questions and provide as much detail in the comments sections as you are comfortable with. ALL SURVEYS WILL BE HELD IN THE STRICTEST OF CONFIDENCE. You have the option to remain anonymous or to be contacted concerning your responses. Note: This survey takes less than 5 minutes to complete.
  • Date Format: MM slash DD slash YYYY
  • (1) Demographics

    Person taking this survey. Select only one answer.
  • (2) Contact Information (Optional)

    If you wish to be contacted by management concerning issues discussed in this survey, please provide name(s) and contact information below. Providing name(s) is OPTIONAL.
  • (3) General Questions

    Select all that apply.
  • Skip if not applicable.
  • Skip if not applicable.
  • (4) SWPCI Office Staff

    Office staff refers to administrative staff like front desk, directors and managers. Exclude comments concerning your counselor(s) in this section.
    Please rate based on issues such as making appointments, friendliness, professionalism etc.
  • Negative and positive comments welcomed.
  • (5) Counselor(s)

  • (5_1) Counselor(s) - Appointments and Sessions

  • Negative and Positive comments welcomed.
  • (5_2) Counselor(s) - Performance and Outcomes

    Please rate based on issues such as making friendliness, abilities and professionalism etc.
  • Negative and Positive comments welcomed.
  • (6) Telehealth Services

  • Positive and negative comments welcome.
  • (7) Still Waters Overall Performane

    Example: Would you recommend SWPCI to a friend, relative, co-worker etc.?
  • Comments and suggestions welcomed.
  • (8) For Internal Use Only

    Used for SWPCI staff, contractors and interns only.