Client Satisfaction Survey
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1.
My therapist demonstrates to me that they understand things from my own point of view & offers clinical support.
(Required.)
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
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2.
My therapist consistently listens to what I am saying without judging me
(Required.)
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
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3.
My therapist consistently shows warmth towards me
(Required.)
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
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4.
My therapist fosters a safe and trusting environment
(Required.)
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
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5.
My therapist begins and finishes all of our session on time, I get a full 50 minute session.
(Required.)
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
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6.
Based on my experience, I would recommend others to work with my therapist.
(Required.)
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
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7.
There are minimal technological glitches during our sessions
(Required.)
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
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8.
If you have not returned to therapy or terminated therapy, please let us know why. (You can choose more than one)
(Required.)
I reached my therapy goals!
I did not reach my therapy goals
The therapist was not a good fit for me
My therapist was full/schedules misaligned
I can't afford it
It was no longer a good time in my life for therapy
I was dissatisfied with the quality of service
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9.
Would you like for someone to contact you to follow up on any concerns you have expressed on this form?
(Required.)
Yes
No
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10.
If you would like to be contacted about your results, please enter your name and contact information below, to remain anonymous type NA:
(Required.)