Client Satisfaction Survey

Thank you for choosing PNBC as your mental health provider. We would like to hear from our clients about how we are doing. Your responses are anonymous as well as confidential. Your responses on this survey will not be posted on a public website and will be used internally to evaluate how we are doing. This form should take less than 5 minutes to complete.

Clinical Staff

Please select the clinician you are providing feedback about: *

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	N/A
I felt she was knowledgable.	Strongly DisagreeI felt she was knowledgable. Strongly Disagree	DisagreeI felt she was knowledgable. Disagree	NeutralI felt she was knowledgable. Neutral	AgreeI felt she was knowledgable. Agree	Strongly AgreeI felt she was knowledgable. Strongly Agree	N/AI felt she was knowledgable. N/A
I felt she was caring.	Strongly DisagreeI felt she was caring. Strongly Disagree	DisagreeI felt she was caring. Disagree	NeutralI felt she was caring. Neutral	AgreeI felt she was caring. Agree	Strongly AgreeI felt she was caring. Strongly Agree	N/AI felt she was caring. N/A
I felt understood.	Strongly DisagreeI felt understood. Strongly Disagree	DisagreeI felt understood. Disagree	NeutralI felt understood. Neutral	AgreeI felt understood. Agree	Strongly AgreeI felt understood. Strongly Agree	N/AI felt understood. N/A
My goals were met by the services I received with this provider.	Strongly DisagreeMy goals were met by the services I received with this provider. Strongly Disagree	DisagreeMy goals were met by the services I received with this provider. Disagree	NeutralMy goals were met by the services I received with this provider. Neutral	AgreeMy goals were met by the services I received with this provider. Agree	Strongly AgreeMy goals were met by the services I received with this provider. Strongly Agree	N/AMy goals were met by the services I received with this provider. N/A
She was on time for my appointment(s).	Strongly DisagreeShe was on time for my appointment(s). Strongly Disagree	DisagreeShe was on time for my appointment(s). Disagree	NeutralShe was on time for my appointment(s). Neutral	AgreeShe was on time for my appointment(s). Agree	Strongly AgreeShe was on time for my appointment(s). Strongly Agree	N/AShe was on time for my appointment(s). N/A
She was professional.	Strongly DisagreeShe was professional. Strongly Disagree	DisagreeShe was professional. Disagree	NeutralShe was professional. Neutral	AgreeShe was professional. Agree	Strongly AgreeShe was professional. Strongly Agree	N/AShe was professional. N/A

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	N/A
I felt she was knowledgable.	Strongly DisagreeI felt she was knowledgable. Strongly Disagree	DisagreeI felt she was knowledgable. Disagree	NeutralI felt she was knowledgable. Neutral	AgreeI felt she was knowledgable. Agree	Strongly AgreeI felt she was knowledgable. Strongly Agree	N/AI felt she was knowledgable. N/A
I felt she was caring.	Strongly DisagreeI felt she was caring. Strongly Disagree	DisagreeI felt she was caring. Disagree	NeutralI felt she was caring. Neutral	AgreeI felt she was caring. Agree	Strongly AgreeI felt she was caring. Strongly Agree	N/AI felt she was caring. N/A
I felt understood.	Strongly DisagreeI felt understood. Strongly Disagree	DisagreeI felt understood. Disagree	NeutralI felt understood. Neutral	AgreeI felt understood. Agree	Strongly AgreeI felt understood. Strongly Agree	N/AI felt understood. N/A
My goals were met by the services I received with this provider.	Strongly DisagreeMy goals were met by the services I received with this provider. Strongly Disagree	DisagreeMy goals were met by the services I received with this provider. Disagree	NeutralMy goals were met by the services I received with this provider. Neutral	AgreeMy goals were met by the services I received with this provider. Agree	Strongly AgreeMy goals were met by the services I received with this provider. Strongly Agree	N/AMy goals were met by the services I received with this provider. N/A
She was on time for my appointment(s).	Strongly DisagreeShe was on time for my appointment(s). Strongly Disagree	DisagreeShe was on time for my appointment(s). Disagree	NeutralShe was on time for my appointment(s). Neutral	AgreeShe was on time for my appointment(s). Agree	Strongly AgreeShe was on time for my appointment(s). Strongly Agree	N/AShe was on time for my appointment(s). N/A
She was professional.	Strongly DisagreeShe was professional. Strongly Disagree	DisagreeShe was professional. Disagree	NeutralShe was professional. Neutral	AgreeShe was professional. Agree	Strongly AgreeShe was professional. Strongly Agree	N/AShe was professional. N/A

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	N/A
I felt she was knowledgable.	Strongly DisagreeI felt she was knowledgable. Strongly Disagree	DisagreeI felt she was knowledgable. Disagree	NeutralI felt she was knowledgable. Neutral	AgreeI felt she was knowledgable. Agree	Strongly AgreeI felt she was knowledgable. Strongly Agree	N/AI felt she was knowledgable. N/A
I felt she was caring.	Strongly DisagreeI felt she was caring. Strongly Disagree	DisagreeI felt she was caring. Disagree	NeutralI felt she was caring. Neutral	AgreeI felt she was caring. Agree	Strongly AgreeI felt she was caring. Strongly Agree	N/AI felt she was caring. N/A
I felt understood.	Strongly DisagreeI felt understood. Strongly Disagree	DisagreeI felt understood. Disagree	NeutralI felt understood. Neutral	AgreeI felt understood. Agree	Strongly AgreeI felt understood. Strongly Agree	N/AI felt understood. N/A
My goals were met by the services I received with this provider.	Strongly DisagreeMy goals were met by the services I received with this provider. Strongly Disagree	DisagreeMy goals were met by the services I received with this provider. Disagree	NeutralMy goals were met by the services I received with this provider. Neutral	AgreeMy goals were met by the services I received with this provider. Agree	Strongly AgreeMy goals were met by the services I received with this provider. Strongly Agree	N/AMy goals were met by the services I received with this provider. N/A
She was on time for my appointment(s).	Strongly DisagreeShe was on time for my appointment(s). Strongly Disagree	DisagreeShe was on time for my appointment(s). Disagree	NeutralShe was on time for my appointment(s). Neutral	AgreeShe was on time for my appointment(s). Agree	Strongly AgreeShe was on time for my appointment(s). Strongly Agree	N/AShe was on time for my appointment(s). N/A
She was professional.	Strongly DisagreeShe was professional. Strongly Disagree	DisagreeShe was professional. Disagree	NeutralShe was professional. Neutral	AgreeShe was professional. Agree	Strongly AgreeShe was professional. Strongly Agree	N/AShe was professional. N/A

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	N/A
I felt she was knowledgable.	Strongly DisagreeI felt she was knowledgable. Strongly Disagree	DisagreeI felt she was knowledgable. Disagree	NeutralI felt she was knowledgable. Neutral	AgreeI felt she was knowledgable. Agree	Strongly AgreeI felt she was knowledgable. Strongly Agree	N/AI felt she was knowledgable. N/A
I felt she was caring.	Strongly DisagreeI felt she was caring. Strongly Disagree	DisagreeI felt she was caring. Disagree	NeutralI felt she was caring. Neutral	AgreeI felt she was caring. Agree	Strongly AgreeI felt she was caring. Strongly Agree	N/AI felt she was caring. N/A
I felt understood.	Strongly DisagreeI felt understood. Strongly Disagree	DisagreeI felt understood. Disagree	NeutralI felt understood. Neutral	AgreeI felt understood. Agree	Strongly AgreeI felt understood. Strongly Agree	N/AI felt understood. N/A
My goals were met by the services I received with this provider.	Strongly DisagreeMy goals were met by the services I received with this provider. Strongly Disagree	DisagreeMy goals were met by the services I received with this provider. Disagree	NeutralMy goals were met by the services I received with this provider. Neutral	AgreeMy goals were met by the services I received with this provider. Agree	Strongly AgreeMy goals were met by the services I received with this provider. Strongly Agree	N/AMy goals were met by the services I received with this provider. N/A
She was on time for my appointment(s).	Strongly DisagreeShe was on time for my appointment(s). Strongly Disagree	DisagreeShe was on time for my appointment(s). Disagree	NeutralShe was on time for my appointment(s). Neutral	AgreeShe was on time for my appointment(s). Agree	Strongly AgreeShe was on time for my appointment(s). Strongly Agree	N/AShe was on time for my appointment(s). N/A
She was professional.	Strongly DisagreeShe was professional. Strongly Disagree	DisagreeShe was professional. Disagree	NeutralShe was professional. Neutral	AgreeShe was professional. Agree	Strongly AgreeShe was professional. Strongly Agree	N/AShe was professional. N/A

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	N/A
I felt she was knowledgable.	Strongly DisagreeI felt she was knowledgable. Strongly Disagree	DisagreeI felt she was knowledgable. Disagree	NeutralI felt she was knowledgable. Neutral	AgreeI felt she was knowledgable. Agree	Strongly AgreeI felt she was knowledgable. Strongly Agree	N/AI felt she was knowledgable. N/A
I felt she was caring.	Strongly DisagreeI felt she was caring. Strongly Disagree	DisagreeI felt she was caring. Disagree	NeutralI felt she was caring. Neutral	AgreeI felt she was caring. Agree	Strongly AgreeI felt she was caring. Strongly Agree	N/AI felt she was caring. N/A
I felt understood.	Strongly DisagreeI felt understood. Strongly Disagree	DisagreeI felt understood. Disagree	NeutralI felt understood. Neutral	AgreeI felt understood. Agree	Strongly AgreeI felt understood. Strongly Agree	N/AI felt understood. N/A
My goals were met by the services I received with this provider.	Strongly DisagreeMy goals were met by the services I received with this provider. Strongly Disagree	DisagreeMy goals were met by the services I received with this provider. Disagree	NeutralMy goals were met by the services I received with this provider. Neutral	AgreeMy goals were met by the services I received with this provider. Agree	Strongly AgreeMy goals were met by the services I received with this provider. Strongly Agree	N/AMy goals were met by the services I received with this provider. N/A
She was on time for my appointment(s).	Strongly DisagreeShe was on time for my appointment(s). Strongly Disagree	DisagreeShe was on time for my appointment(s). Disagree	NeutralShe was on time for my appointment(s). Neutral	AgreeShe was on time for my appointment(s). Agree	Strongly AgreeShe was on time for my appointment(s). Strongly Agree	N/AShe was on time for my appointment(s). N/A
She was professional.	Strongly DisagreeShe was professional. Strongly Disagree	DisagreeShe was professional. Disagree	NeutralShe was professional. Neutral	AgreeShe was professional. Agree	Strongly AgreeShe was professional. Strongly Agree	N/AShe was professional. N/A

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	N/A
I felt she was knowledgable.	Strongly DisagreeI felt she was knowledgable. Strongly Disagree	DisagreeI felt she was knowledgable. Disagree	NeutralI felt she was knowledgable. Neutral	AgreeI felt she was knowledgable. Agree	Strongly AgreeI felt she was knowledgable. Strongly Agree	N/AI felt she was knowledgable. N/A
I felt she was caring.	Strongly DisagreeI felt she was caring. Strongly Disagree	DisagreeI felt she was caring. Disagree	NeutralI felt she was caring. Neutral	AgreeI felt she was caring. Agree	Strongly AgreeI felt she was caring. Strongly Agree	N/AI felt she was caring. N/A
I felt understood.	Strongly DisagreeI felt understood. Strongly Disagree	DisagreeI felt understood. Disagree	NeutralI felt understood. Neutral	AgreeI felt understood. Agree	Strongly AgreeI felt understood. Strongly Agree	N/AI felt understood. N/A
My goals were met by the services I received with this provider.	Strongly DisagreeMy goals were met by the services I received with this provider. Strongly Disagree	DisagreeMy goals were met by the services I received with this provider. Disagree	NeutralMy goals were met by the services I received with this provider. Neutral	AgreeMy goals were met by the services I received with this provider. Agree	Strongly AgreeMy goals were met by the services I received with this provider. Strongly Agree	N/AMy goals were met by the services I received with this provider. N/A
She was on time for my appointment(s).	Strongly DisagreeShe was on time for my appointment(s). Strongly Disagree	DisagreeShe was on time for my appointment(s). Disagree	NeutralShe was on time for my appointment(s). Neutral	AgreeShe was on time for my appointment(s). Agree	Strongly AgreeShe was on time for my appointment(s). Strongly Agree	N/AShe was on time for my appointment(s). N/A
She was professional.	Strongly DisagreeShe was professional. Strongly Disagree	DisagreeShe was professional. Disagree	NeutralShe was professional. Neutral	AgreeShe was professional. Agree	Strongly AgreeShe was professional. Strongly Agree	N/AShe was professional. N/A

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	N/A
I felt she was knowledgable.	Strongly DisagreeI felt she was knowledgable. Strongly Disagree	DisagreeI felt she was knowledgable. Disagree	NeutralI felt she was knowledgable. Neutral	AgreeI felt she was knowledgable. Agree	Strongly AgreeI felt she was knowledgable. Strongly Agree	N/AI felt she was knowledgable. N/A
I felt she was caring.	Strongly DisagreeI felt she was caring. Strongly Disagree	DisagreeI felt she was caring. Disagree	NeutralI felt she was caring. Neutral	AgreeI felt she was caring. Agree	Strongly AgreeI felt she was caring. Strongly Agree	N/AI felt she was caring. N/A
I felt understood.	Strongly DisagreeI felt understood. Strongly Disagree	DisagreeI felt understood. Disagree	NeutralI felt understood. Neutral	AgreeI felt understood. Agree	Strongly AgreeI felt understood. Strongly Agree	N/AI felt understood. N/A
My goals were met by the services I received with this provider.	Strongly DisagreeMy goals were met by the services I received with this provider. Strongly Disagree	DisagreeMy goals were met by the services I received with this provider. Disagree	NeutralMy goals were met by the services I received with this provider. Neutral	AgreeMy goals were met by the services I received with this provider. Agree	Strongly AgreeMy goals were met by the services I received with this provider. Strongly Agree	N/AMy goals were met by the services I received with this provider. N/A
She was on time for my appointment(s).	Strongly DisagreeShe was on time for my appointment(s). Strongly Disagree	DisagreeShe was on time for my appointment(s). Disagree	NeutralShe was on time for my appointment(s). Neutral	AgreeShe was on time for my appointment(s). Agree	Strongly AgreeShe was on time for my appointment(s). Strongly Agree	N/AShe was on time for my appointment(s). N/A
She was professional.	Strongly DisagreeShe was professional. Strongly Disagree	DisagreeShe was professional. Disagree	NeutralShe was professional. Neutral	AgreeShe was professional. Agree	Strongly AgreeShe was professional. Strongly Agree	N/AShe was professional. N/A

Feedback for your clinician

Administrative Staff

Please rate your experiences in communicating with Alexia Salcedo, our Patient Care Coordinator/Scheduler.

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	N/A
She returned my call within 24 hours.	Strongly DisagreeShe returned my call within 24 hours. Strongly Disagree	DisagreeShe returned my call within 24 hours. Disagree	NeutralShe returned my call within 24 hours. Neutral	AgreeShe returned my call within 24 hours. Agree	Strongly AgreeShe returned my call within 24 hours. Strongly Agree	N/AShe returned my call within 24 hours. N/A
She explained things well.	Strongly DisagreeShe explained things well. Strongly Disagree	DisagreeShe explained things well. Disagree	NeutralShe explained things well. Neutral	AgreeShe explained things well. Agree	Strongly AgreeShe explained things well. Strongly Agree	N/AShe explained things well. N/A
I felt like she heard me and was trying to help.	Strongly DisagreeI felt like she heard me and was trying to help. Strongly Disagree	DisagreeI felt like she heard me and was trying to help. Disagree	NeutralI felt like she heard me and was trying to help. Neutral	AgreeI felt like she heard me and was trying to help. Agree	Strongly AgreeI felt like she heard me and was trying to help. Strongly Agree	N/AI felt like she heard me and was trying to help. N/A
She was professional.	Strongly DisagreeShe was professional. Strongly Disagree	DisagreeShe was professional. Disagree	NeutralShe was professional. Neutral	AgreeShe was professional. Agree	Strongly AgreeShe was professional. Strongly Agree	N/AShe was professional. N/A
The e-mail she sent was clear.	Strongly DisagreeThe e-mail she sent was clear. Strongly Disagree	DisagreeThe e-mail she sent was clear. Disagree	NeutralThe e-mail she sent was clear. Neutral	AgreeThe e-mail she sent was clear. Agree	Strongly AgreeThe e-mail she sent was clear. Strongly Agree	N/AThe e-mail she sent was clear. N/A

Please rate your experiences in communicating with Stephanie Canisalez, our Biller.

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	N/A
She verified my benefits within 48 hours.	Strongly DisagreeShe verified my benefits within 48 hours. Strongly Disagree	DisagreeShe verified my benefits within 48 hours. Disagree	NeutralShe verified my benefits within 48 hours. Neutral	AgreeShe verified my benefits within 48 hours. Agree	Strongly AgreeShe verified my benefits within 48 hours. Strongly Agree	N/AShe verified my benefits within 48 hours. N/A
She explained things well.	Strongly DisagreeShe explained things well. Strongly Disagree	DisagreeShe explained things well. Disagree	NeutralShe explained things well. Neutral	AgreeShe explained things well. Agree	Strongly AgreeShe explained things well. Strongly Agree	N/AShe explained things well. N/A
I felt like she was trying to help.	Strongly DisagreeI felt like she was trying to help. Strongly Disagree	DisagreeI felt like she was trying to help. Disagree	NeutralI felt like she was trying to help. Neutral	AgreeI felt like she was trying to help. Agree	Strongly AgreeI felt like she was trying to help. Strongly Agree	N/AI felt like she was trying to help. N/A
She was professional.	Strongly DisagreeShe was professional. Strongly Disagree	DisagreeShe was professional. Disagree	NeutralShe was professional. Neutral	AgreeShe was professional. Agree	Strongly AgreeShe was professional. Strongly Agree	N/AShe was professional. N/A

Feedback for administrative staff

If you have feedback for Alexia or Stephanie, please write it here.

Clinical Staff

Administrative Staff

Other Questions