Therapy Feedback

Therapy Feedback

Your comments and suggestions will help us serve you better. Your feedback is completely anonymous (we can not identify you from this form). We keep your input confidential, unless you consent to allow us to use your comments anonymously.
Your Therapist
Which therapist worked with you?

At first, how did you feel about the issue you came here to address?*

	1	2	3	4	5

1 is Some concern, 5 is Overwhelming concern

Now, how do you feel about the issue you came to address?*

	1	2	3	4	5

1 is Not improved, 5 is Greatly improved

How would you describe your therapist's understanding of your concerns:*

	1	2	3	4	5

1 is Low, 5 is High

How would you describe your therapist's overall effectiveness:*

	1	2	3	4	5

1 is Low, 5 is High

What part of your work in therapy helped you the most?*
What part of your work in therapy was least helpful to you?*
If your therapy work with us has ended, what is your main reason for ending?*
Any additional comments, suggestions, or thoughts?*
Can we use some of your feedback in our promotional materials (anonymously)

YesNo
Thank you.

Your feedback is very important to us. Your input will help make therapy services more effective for everyone. We appreciate your comments.
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