Client Satisfaction Survey

Please assign a number, 1 through 5 (with 1 being extremely dissatisfied, and 5 being extremely satisfied), to each of the following statements.

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Name:
Group Name:

Utilization
Management		 Care
Management		 Comments
Overall Level of Service
1 2 3 4 5
1 2 3 4 5
Responsiveness to your needs
1 2 3 4 5
1 2 3 4 5
Problem Solving (willingness, ability, timeliness, appropriateness)
1 2 3 4 5
1 2 3 4 5
Your Employee's Satisfaction
1 2 3 4 5
1 2 3 4 5
Timeliness of Reports
1 2 3 4 5
1 2 3 4 5
Content of Reports (Appropriateness, Usefulness, Completeness)
1 2 3 4 5
1 2 3 4 5
Adequacy of Savings
1 2 3 4 5
1 2 3 4 5
Ease of Communication
1 2 3 4 5
1 2 3 4 5
Adequacy of Communication
1 2 3 4 5
1 2 3 4 5
Appropriateness of Communication
1 2 3 4 5
1 2 3 4 5
Value of Service / Products
1 2 3 4 5
1 2 3 4 5
Cost to Benefit Ratio
1 2 3 4 5
1 2 3 4 5
Return on Investment
1 2 3 4 5
1 2 3 4 5
Soundness of Recommendations or Exceptions
1 2 3 4 5
1 2 3 4 5
Flexibility of UM / CM
1 2 3 4 5
1 2 3 4 5
Consistency of UM / CM
1 2 3 4 5
1 2 3 4 5
Reliability of UM / CM
1 2 3 4 5
1 2 3 4 5
Knowledge of UM / CM staff
1 2 3 4 5
1 2 3 4 5
Personalization / Customization of Service
1 2 3 4 5
1 2 3 4 5
Attention to Detail
1 2 3 4 5
1 2 3 4 5
Smoothness of Transition from Previous Provider
1 2 3 4 5
1 2 3 4 5
Useful in Improving Employee Moral & Retention
1 2 3 4 5
1 2 3 4 5
Decreased Worker Absences as a Result of Services
1 2 3 4 5
1 2 3 4 5



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