Coastal Counseling Center
Satisfaction Survey after Completion of Services
Now that you have completed counseling, please complete this survey . . .
What was the name of the therapist you saw for counseling?
*
Which counseling program were your enrolled in?
*
Individual counseling
Couples / marriage counseling
Family counseling
Anger Management
Substance abuse counseling
Other
Since completing services, please indicate the amount of improvement you have had in:
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Worsened
No change
Slight improvement
Noticeable improvement
Great improvement
My personal life
My family relationships
My job / school performance
My mood and/or anxiety
My ability to handle problems
My attitude and outlook in general
Please share any comments about your responses above
Now that I have completed treatment, I am (we are) better able to manage our difficulties
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Yes
No
Uncertain
Recommendations:
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Definitely yes
Yes
Neutral
No
Definitely no
I would recommend my counselor to others who need help
I would recommend Coastal Counseling Center to others
Please share any final comments to help us improve our services to the community:
Please complete the demographic information below
Your Age
*
Please Select
12-17
18-19
20-29
30-39
40-49
50-59
60-69
70 and above
Your Gender
*
Please Select
Male
Female
Your Race
*
Please Select
African-American
Hispanic
Caucasian
Native American
Asian
Biracial
Your Marital Status
*
Please Select
Never married
Living together
Married
Separated
Divorced
Widowed
Submit
Should be Empty: