SpeechEase Feedback Questionnaire

We love hearing from our clients with any and all feedback that they have to give, whether that be a complaint, constructive criticism or positive feedback. It's your opportunity to make a difference and will help direct changes and improvements to SpeechEase.

Therapy outcomes are all based on the relationship between the client, their family/support network and the therapist - which is built on speaking openly and honestly with each other. However, we know that sometimes it can be hard to have delicate conversations and you would rather tell us your thoughts anonymously.

If you would like to give us feedback, please complete our questionnaire in as much detail as you feel comfortable sharing. Please be rest assured, providing us with any feedback (good or bad) will not impact you adversely in any way.

The questionnaire will take approximately 10 minutes and is private and confidential unless you choose to provide your contact details for a direct follow up with our Director Kate Thomson.

1. Are you making a complaint or giving a compliment / providing general feedback on your experience with us? *This question is required.

2. Date of complaint *This question is required. This question requires a valid date format of MM/DD/YYYY.

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2. Date of feedback *This question is required. This question requires a valid date format of MM/DD/YYYY.

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2. Please select which clinic your feedback refers to. *This question is required.

3. What does your complaint relate to? *This question is required.

Quality of service
Facilities
SpeechEase team member
Pricing
Communication
Appointment availability
Other Please enter an 'other' value for this selection.

3. Please outline your complaint below and in as much detail as you feel comfortable giving. *This question is required.

3. Please provide suggestions on how you would like to see your complaint resolved. *This question is required.

3. We love receiving positive feedback and suggestions for improvement. We see it like a suggestion box but online.

Please let us know how we are doing in as much detail as you feel comfortable giving. *This question is required.

3. Which of the following (if any) would you say are SpeechEase's greatest strengths?

3. Which of the following (if any) should SpeechEase focus on improving?

3. How likely are you to recommend SpeechEase to your friends/family?

0 - Very Unlikely
10 - Very Likely *This question is required.

0	1	2	3	4	5	6	7	8	9	10
0	1	2	3	4	5	6	7	8	9	10

3. What could SpeechEase do to make things better?

3. Could SpeechEase do something that would make you want to tell others this is a great clinic and refer them?

3. What would you tell people (or have you told people) about SpeechEase?

3. Are you considering looking for a service elsewhere? *This question is required.

3. Is there any reason you would consider looking for a service elsewhere?

3. What is your main reason for considering leaving?

3. Do you have any further comments or feedback for us?

3. Do you have any further comments or feedback?

3. If you would like Kate to contact you in regards to your complaint, please provide your name and email address below and she will be in touch within 2 business days.

First Name

Email Address

3. If you would like Kate to contact you in regards to your feedback, please provide your name and email address below and she will be in touch as soon as possible.

First Name

Email Address

3. Privacy Policy *This question is required.

I confirm I have read and agree to SpeechEase’s Privacy Policy

SpeechEase Feedback Questionnaire

SpeechEase Client Feedback, Compliments and Complaints Form