Client Experience and Satisfaction Survey
To make sure that you are receiving quality services, please complete this questionnaire. 
Items with a "*" are required

Please answer the following questions about your experience

1 star is Poor and 5 stars is Excellent 

To what extent did your therapist help you achieve the purpose for what you sought counseling?*

PoorFairGoodVery goodExcellent

To what extent did your therapist help you obtain skills that will help you handle future problems?* 

PoorFairGoodVery goodExcellent

To what extent did your therapist show interest in your needs?*

PoorFairGoodVery goodExcellent

To what extent did your therapist understand your needs?* 

PoorFairGoodVery goodExcellent

To what extent did your therapist help you define your needs?* 

PoorFairGoodVery goodExcellent

To what extent did your therapist involve you in the treatment planning process (such as treatment goals and frequency of appointments)?* 

PoorFairGoodVery goodExcellent

To what extent did your therapist respond to your requests for services?*  

PoorFairGoodVery goodExcellent

Thanks for sharing your feedback with us!