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EAP Feedback Questionnaire

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EAP Feedback Questionnaire Powered By Docstoc
					                            OCCUPATIONAL MEDICINE CLINIC
                   EMPLOYEE ASSISTANCE PROGRAM
                            FEEDBACK QUESTIONNAIRE

We appreciate your help evaluating our services by answering the questions
below. Thank you.


   1) To send a hard copy: Print the form and complete. Mail to EAP, Building 490, or
      place in the Suggestion Box in the OMC Waiting Area.

   2) To send via e-mail: Open a new mail message [select: file > send > page by e-mail]
      and address to: eap@bnl.gov. Open the form and complete online. Save the form
      before sending.


                                           Excellent Very Good        Good   Poor   NA
     Phone staff courtesy/helpfulness
     Appointment prompt enough
     Convenience of office location
     Privacy of waiting area/offices
     Psychologist’s
     understanding/concern
     Psychologist’s helpfulness
     Confidentiality respected
     Overall satisfaction


  Would use EAP services again: Yes                    No         Not Sure

  How could EAP services be improved?


  Any comments?



  Date:                      Name
                                                         (OPTIONAL)



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Jun Wang Jun Wang Dr
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