CONCERN: EAP
Satisfaction Survey for Counseling Services

DATE: __________________

Please take a few moments to tell us how you feel about your experience with our services. Your response is completely confidential and greatly appreciated.

If you are a CONCERN: EAP client, what is the name of your organization?
__________________________________________________________________

How would you rate how well you were informed about our services before you called?
Excellent Very Good Good Fair Poor

How would you rate the reasonableness of the time needed to schedule an appointment?
Excellent Very Good Good Fair Poor

How would you rate the helpfulness and pleasantness of the telephone referral staff?
Excellent Very Good Good Fair Poor

How would you rate your counselor’s knowledge and competency?
Excellent Very Good Good Fair Poor

How would you rate the helpfulness of our services in dealing with your problem?
Excellent Very Good Good Fair Poor

What is the likelihood that you would use our services again if you needed them?
Excellent Very Good Good Fair Poor

What is the likelihood you would recommend our services to your co-workers or
family members?
Excellent Very Good Good Fair Poor

What is your overall rating of our services?
Excellent Very Good Good Fair Poor

What did you like best about our services?

What could we do to improve our services?

Other comments?

Your counselor’s name (optional): ______________________________________

If there is anything about our services that you would like to discuss,
please contact a Clinical Manager at 800-344-4222 or 650-940-7100.
Please fax this survey back to us at (650) 965-2849         Return to Contact page