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Client Full Name
Birthday
Month
Day
Year
1. Administration was fast and attentive to get my treatment started:
Agree
Disagree
Comments
2. Administration was on top of communication and quick to act:
Agree
Disagree
Comments
3. My Provider was warm and friendly:
Agree
Disagree
Comments
4. My Provider seemed to sincerely care about me:
Agree
Disagree
Comments
5. My Provider really listened to me:
Agree
Disagree
Comments
6. My Provider showed respect for my cultural background:
Agree
Disagree
Comments
7. I was able to find new ways of handling my mental health concerns as a result of treatment:
Agree
Disagree
Comments
8. My mental health concerns were resolved to my satisfaction as a result of treatment:
Agree
Disagree
Comments
9. I would recommend CLTatum & Associates Behavioral Healthcare to a friend:
Agree
Disagree
Comments
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