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Anonymous survey to assess client satisfaction with my work.

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* 1. How old is the client?

For each question, please mark a number to show how much you agree with the statement. Use a scale from 1 = "I completely disagree" to 7 = "I completely agree." If the statement does not apply to you or your experience, please mark NA.

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* 2. I was treated with courtesy and respect by the clinician.

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* 3. I felt heard, connected with and understood by the clinician.

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* 4. I experienced improvement in the condition or problems for which I sought services.

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* 5. We worked on and talked about what I wanted to work on and talk about.

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* 6. I felt that the visits were useful.

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* 7. If the need to speak to someone arises again, I would return to this clinician.

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* 8. Please add any other comments you wish about your experience with us. Thank you very much for your time and efforts.