Patient Survey‎ > ‎


PRIVACY INFORMATION:  The information in this survey is accessible only by our Office Manager and Clinical/Executive Director.  It will remain private and anonymous unless you allow us to use your information or if we are required by law to disclose it.  

For all survey responses, we use the information in combination with other surveys and feedback to better serve our patients.  You can choose whether or not we disclose the responses to a specific counselor and/or if your name is used. 

IMPORTANT NOTE:  All of the survey responses are stored on our Google server.  All the information is maintained under strict security and encryption protocols at Google.  We are confident in the security of the Google system, and the file system meets the criteria for HIPAA standards.   By choosing to use this online form, you acknowledge that the data is stored in our Google account, agree to submit your responses through this online form, and give permission to CCNPS to receive your responses via Google. You do not have to include any personally identifying information (name, address, etc)  on the online form.  By completing the online survey, you  are giving us permission to have this data processed and/or stored in our Google account.   
Instead, if you would rather complete a paper version of the form, please contact us.