Buddy Kemp Customer Satisfaction Survey

Buddy Kemp Cancer Support Center

Customer Satisfaction Survey

Presbyterian Buddy Kemp Cancer Support Center is committed to providing excellent care and services to the patients we serve in the community. In order to do that, we need information from you. Please take a few minutes to answer questions about the services we provide. All information is confidential and will be used to improve our future services.

Thank you for your time.

*Denotes required fields


*Date:	(mm/dd/yyyy)

*County:	Enter "N/A" if not known

*Ethnicity:	African American Asian Caucasion Hispanic Native American Other:

*What services did you receive at the Buddy Kemp Caring House?
Counseling Support Group Case Management Other:

*What is your age?	< 18 18-30 31-40 41-50 51-60 61-70 >70

*What is your sex?	Male Female

*Please rate how well our staff showed courtesy and respect from your initial point of contact with us.
Excellent Very Good Good Fair Poor Did Not Use

*Please rate how well our staff was available to answer questions, return phone calls, schedule appointments, etc.
Excellent Very Good Good Fair Poor Did Not Use

*Please rate how well our staff provided you with counseling to help you understand and cope with your condition and manage your emotions.
Excellent Very Good Good Fair Poor Did Not Use

*Timeliness of responses for services (counseling, communication, case management).
Excellent Very Good Good Fair Poor Did Not Use

*Please rate the services and information received from case management (financial and referrals to other community agencies).
Excellent Very Good Good Fair Poor Did Not Use

*Please rate the overview you were given of the services offered at the Buddy Kemp Caring House, including the Resource Library.
Excellent Very Good Good Fair Poor Did Not Use

*Overall, how would you rate the quality of care and services provided? If not excellent, why?
Excellent Very Good Good Fair Poor Did Not Use

We would appreciate feedback or suggestions you may have to enhance our services.

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