Customer Service Survey

Customer Service Survey
Please respond to the following questions openly and honestly. Your opinions are important to us, as we would like to provide the best service possible!
Full Name*

First NameLast Name
Approximately how long has your child been attending First Words Speech Services?
Why did you choose First Words Services?

Please rate the following items

	Very Satisfied	Satisfied	Somewhat Satisfied	Not Satisfied
Ability to reach us
Ease of Scheduling
Convenience of appointment times and availability
Services
Appearance of office
Courteousness of staff
Promptness is receiving services after initial evaluation
Explanation of services provided
Quality of referrals (if applicable)

Please rate the following items

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
We accommodate your schedule when booking your appointment
The waiting time is short and acceptable
Clinic rules and policies are communicated in an understandable manner
I am treated with respect
My child receives an adequate amount of time with the clinician
My concerns are adequately addressed
Information I have received has been helpful
My questions are answered clearly, completely and to my satisfaction
Homework is realistic, relevant and explained clearly

Rate your level of satisfaction with the progress your child is making
What specifically are you satisfied or dissatisfied with?
Rate your level of overall satisfaction with First Words Speech Services
What specifically are you satisfied or dissatisfied with?
How likely are you to recommend First Words Speech Services to others?
Additional Comments or Suggestions
Thank you for taking the time to complete this survey!
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