COUNSELING SURVEY

Please take moment to answer a few questions so that this office can provide the best service possible. (This survey is optional but very much appreciated. All of your responses are strictly CONFIDENTIAL and no one will call you regarding your answers.) Thank you for your time in completing this survey and please contact us again whenever we can be of service.

A. Was your appointment se up in a timely manner?

Poor Fair Good Very Good Excellent
B. Did you find the office at a convenient location?

Poor Fair Good Very Good Excellent
C. Did you find the office to be comfortable and conducive to your counseling experience?

Poor Fair Good Very Good Excellent
D. Since therapy began, how would you rate your improvements?

Poor Fair Good Very Good Excellent
E. Were your personal goals achieved?

Poor Fair Good Very Good Excellent
F. Would you recommend your therapist to others?

Poor Fair Good Very Good Excellent
Comments and Suggestions???
Name (Optional) First Last
Email (Optional)
Thank you for your time in completing this survey and please contact us again whenever we can be of service.


Poor		Fair		Good		Very Good		Excellent


Poor		Fair		Good		Very Good		Excellent


Poor		Fair		Good		Very Good		Excellent


Poor		Fair		Good		Very Good		Excellent