CONFIDENTIAL QUESTIONNAIRE
COMPANY (CONTRACT): ______________________________________
Your Employee Assistance Program (EAP) is designated as a benefit for employees and their eligible family members. We care about the quality of the service we provide you and would appreciate your helping us by telling us what you think about the services you received.
Although we would prefer to receive your completed questionnaire immediately following your appointment, you may complete it later and return it to us. The completed questionnaire should be given to our Call Center Manager or mailed to our Call Center at the address on the bottom of this page.
Strongly Strongly
Disagree Agree
I was treated with courtesy and respect. 1 2 3 4 5 I was scheduled an appointment in a timely manner. 1 2 3 4 5 I feel confident that the program maintained my confidentiality. 1 2 3 4 5 I am satisfied with the assistance I received from the program. 1 2 3 4 5 I feel that my counselor provided me with helpful suggestions 1 2 3 4 5
and strategies for dealing with my problem.
What comments do you have regarding the service you received?
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What suggestions or changes would you recommend to make the EAP services better?
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Would you use the EAP again or recommend it to others?
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PLEASE DO NOT WRITE YOUR NAME ON THIS QUESTIONNAIRE.
THANK YOU!
5372 Fallowater Lane, Suite B, Roanoke, VA 24014 Phone (800) 950 - 3434 Fax (540) 776-5725
