top of page

Client Feedback Form

This form Allows you an apportunity to provide feedback to your therapist. This will help improve the service offered to you and to others.

***You DO NOT need to identify yourself ****

PLEASE MARK THE BOX WHICH MOST CLOSELY CORRESPONDS TO HOW YOU FEEL EACH STATEMENT:

My therapist is:

ABOUT THE WORKING RELATIONSHIP WITH THE THERAPIST I was given an appointment in a reasonable amount of time.

arrow&v

My therapist fostered a safe and trusting environment.

arrow&v

My Therapist Showed warmth toward me.

arrow&v

My therapist accepted what I said without judging me.

arrow&v

My Therapist listened carefully to my problems and needs and addressed them properly.

arrow&v

My therapist was professional and knowledgeable in helping me with my problems / concerns.

arrow&v

My therapist focused on what was important to me.

arrow&v

My Therapist challanged me when / if that was appropriate.

arrow&v

My therapist started and ended our sessions on time.

arrow&v

ABOUT THE RESULT OF WORKING WITH YOUR THERAPIST The sessions with my therapist helped me with whatever originally led me to seek counseling.

arrow&v

I have learned valuable skills since I began therapy.

arrow&v

I can solve my problems more easily as a result of my therapy.

arrow&v

Any Changes which might have occured in me as a result of my counseling have been positive.

arrow&v

OVERALL SATISFACTION My overall level of satisfaction with the service provided by my therapist is:

arrow&v

Based on my experience, I would recommend my therapist to others

arrow&v

Please use the space below for any further comments you would like to bring to your therapist's attention.

THANK YOU !

(Individual counseling, family counseling, couples and marriage counseling, counseling for children and adolescents, counseling for depression & anxiety, anger management, grief and trauma counseling, Rochester, Michigan) 

bottom of page