Prism Health Networks

Prism Quality EAP

2732 Transit Road, West Seneca, NY 14224

Phone: 1-888-276-6632 Fax: (716) 712-2796

E-mail: EAP@prismnetwork.com

Prism Quality EAP

Client Satisfaction Survey

Dear EAP client: Please take a few minutes to complete and return this survey. Your responses are kept confidential and are utilized to ensure customer satisfaction and improve EAP services. Please contact us at 1-888-276-6632 with any questions. Thank you!

The response scale is numbered from 1 (Disagree Strongly) to 5 (Agree Strongly). Please select the number that most closely matches the way you feel about the statement. Not applicable or no opinion would be rates as "NA".

						Disagree			Agree
						Strongly			Strongly

The EAP assisted me with my concerns.

1	2	3	4	5
					NA

Please state where your EAP appointment took place.

This location was convenient for me.

1	2	3	4	5
					NA

The appointment time and date were convenient for me.

1	2	3	4	5
					NA

I think the EAP is a valuable company benefit.

1	2	3	4	5
					NA

I heard about the EAP Program through: ( check all that apply)

Company Literature, Human Resources, Management, Seminar, Union,

Co-Worker, Other

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If your appointment with the EAP was due to an Administrative Referral made by your employer, please answer questions 7 through 10.

The EAP helped me to understand why my employer referred me to EAP.

1	2	3	4	5
					NA

The referral paperwork and authorization forms were easy to understand.

1	2	3	4	5
					NA

My work performance has improved since utilizing the EAP.

1	2	3	4	5
					NA

10.

My work attendance has improved since utilizing the EAP.

1	2	3	4	5
					NA

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11.

I currently participate in Health & Wellness/Fitness activities

Yes No

12.

I discussed Health & Wellness information with my counselor.

Yes No

13.

If yes, the EAP was a helpful resource for information regarding exercise, nutrition and access to Health & Wellness programs in the community.

1	2	3	4	5
					NA

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OPTIONAL INFORMATION

I would like to be contacted by a Prism employee to learn more about Health and Wellness Programs that may be available to me. I can be reached at:

Name: Phone # H W C (check one)

Address : Best time to call:

City :

State Zip E-mail Address

The information found on this Website, including that found in the "Requesting Services" section is provided as a general educational aid to our users and is not a substitute for services provided by a qualified healthcare provider or other professional person who is familiar with your unique situation. This information is not intended to supersede your employer's policies and procedures or meant to be used in place of professional legal or medical advice.