PTS Satisfaction Survey
1.
Respondent's Name (will remain confidential)
2.
On a scale of 0 to 10,
How likely is it that you would recommend Pietruck Therapy Services PLLC to a friend or colleague?
0 for Not at all likely, 10 for Extremely likely
Not at all likely
Extremely likely
0
1
2
3
4
5
6
7
8
9
10
3.
What brought you into therapy?
ADHD/ADD
Anxiety
Depression
Gender Identity/Sexual Identity
Grief & Loss
Life Transition/Adjustment
OCD
Parenting
Personal Empowerment/Development
School/Work Stressors
Substance Use
Trauma
Women's Health
Other (please specify)
4.
How would you rate your overall experience in therapy?
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
Other (please specify)
5.
How well did the provider address the goals that brought you into therapy?
Extremely well
Very well
Somewhat well
Not so well
Not at all
6.
Is there anything else we could have done to improve your experience in therapy and/or with PTS staff in general?
7.
Please share a brief narrative about your overall therapy experience.
8.
What was the best part of your experience with your provider?
9.
Do you give permission to Pietruck Therapy Services PLLC to use feedback on this anonymous form for promotional purposes?
