CLIENT FEEDBACK

Your feedback is important to us as it allows us to provide the best quality care and service for you the client. Please take a moment to fill in the following survey. After reading each comment below, please indicate your answer by selecting the response that best describes your experience.

Date *

Psychologist Name *

First Name

Last Name

Client's Name

1. My therapist was warm, friendly and accepting. *

Strongly Disagree Disagree Agree Strongly Agree

2. I felt that my therapist had the skills to help me achieve my goals. *

Strongly Disagree Disagree Agree Strongly Agree

3. The admin staff was efficient and helpful in processing payments an scheduling appointments. *

Strongly Disagree Disagree Agree Strongly Agree

4. I found the admin staff warm and friendly. *