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Exit Survey
 
 
Is this your first time in therapy?
 
Yes
 
No
 
 
How satisfied are you with the following:
Very Unsatisfied Unsatisfied Neutral Satisfied Very Satisfied N/A
Return Telephone Call
Availability of Appointment Times
Follow Up By Clinician After Appointment
 
 
 
Compared to our competitors, how effective is our software?
 
Much more effective
 
Somewhat more effective
 
Slightly more effective
 
About as effective
 
Slightly less effective
 
Somewhat less effective
 
Much less effective
 
 
 
Overall, are you satisfied with the performance of the software?
 
Extremely satisfied
 
Moderately satisfied
 
Slightly satisfied
 
Neither satisfied nor dissatisfied
 
Slightly dissatisfied
 
Moderately dissatisfied
 
Extremely dissatisfied
 
 
 
How likely are you to recommend our company?
 
Extremely likely
 
Very likely
 
Moderately likely
 
Slightly likely
 
Not at all likely
 
 
 
How often would you like to receive our newsletter?
 
Weekly
 
Every two weeks
 
Monthly
 
Quarterly
 
Semi-annually
 
Annually
 
 
 
How much of our newsletter do you read?
 
A quarter or less
 
From a quarter to half
 
Half to three-quarters
 
More than three-quarters
 
 
 
What is your overall satisfaction with the newsletter?
 
Very satisfied
 
Somewhat satisfied
 
Neutral
 
Somewhat dissatisfied
 
Very dissatisfied
 
 
 
How likely you would recommend our products to a friend or colleague?
 
Very likely
 
Somewhat likely
 
Neutral
 
Somewhat unlikely
 
Very unlikely
 
 
 
Have you ever recommended us to others?
 
No, never recommended
 
Have recommended once or twice
 
Have recommended several times