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CSS Client Satisfaction Survey
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11
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HIPAA
Compliance
1
How would you rate your overall experience with Cancer Support Sonoma?
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2
How would you rate the CSS Patient Navigator?
Responsiveness
Knowledgeability
Friendliness
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Responsiveness
Knowledgeability
Friendliness
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3
How would you rate the Cancer Support Sonoma clinic space and office?
Comfort of the treatment room
Cleanliness of CSS clinic space
Location/parking accessibility
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Comfort of the treatment room
Cleanliness of CSS clinic space
Location/parking accessibility
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4
Which service(s) did you receive at Cancer Support Sonoma?
Oncology Massage
Acupuncture
Counseling/Psychotherapy
Group Support Session
Health Navigation/Intake
Jin Shin Jyutsu
Lymphatic Massage
Naturopathic Consultation
Ayurvedic Consultation
Other
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5
Please rate your satisfaction with the specific services you received.
Mark N/A if you did NOT receive that service.
N/A
Not Satisfied
Somewhat Satisfied
Satisfied
Very Satisfied
Oncology/lymphatic Massage
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Acupuncture
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Psychotherapy
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Therapeutic Massage
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Group Therapy Session
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Jin Shin Jyutsu
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Naturopathic Consultation
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Oncology/lymphatic Massage
Acupuncture
Psychotherapy
Therapeutic Massage
Group Therapy Session
Jin Shin Jyutsu
Naturopathic Consultation
N/A
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Not Satisfied
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Somewhat Satisfied
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Satisfied
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Very Satisfied
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N/A
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Not Satisfied
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Somewhat Satisfied
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Satisfied
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Very Satisfied
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N/A
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Not Satisfied
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Somewhat Satisfied
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Satisfied
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Very Satisfied
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N/A
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Not Satisfied
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Somewhat Satisfied
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Satisfied
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Very Satisfied
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N/A
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Not Satisfied
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Somewhat Satisfied
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Satisfied
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Very Satisfied
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N/A
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Not Satisfied
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Somewhat Satisfied
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Satisfied
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Very Satisfied
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N/A
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Not Satisfied
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Satisfied
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Very Satisfied
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6
Were there any barriers to your ability to obtain services at CSS?
If so, please describe them here.
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7
What other types of services would you like to see at CSS?
Please describe them here.
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8
Do you have any other suggestions or feedback?
If so, please share them here.
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9
Do you want to submit this survey anonymously?
You may leave your name at the end of the survey if you would like to be contacted about your responses.
YES
NO
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10
May we quote your feedback in our future promotional materials?
Quotations will be anonymous and/or de-identified to protect privacy.
YES
NO
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11
Share your name here.
OPTIONAL
First Name
Last Name
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