FEEDBACK…

Please help me improve my practice by answering some questions. I’m interested in your honest opinions, whether they are positive or negative. Please answer all of the questions. I especially welcome your comments and suggestions. Thank you; I really appreciate your help.

Name (Optional)

How would you rate the quality of care you have received from my practice?

• Excellent
• Good
• Fair
• Poor

Did you feel heard and understood?

• Yes, definitely
• Yes, generally
• No, not really
• No, definitely not

Did you feel respected and valued?

• Yes, definitely
• Yes, generally
• No, not really
• No, definitely not

Have your sessions been helpful in dealing with your needs?

• Yes, definitely
• Yes, generally
• No, not really
• No, definitely not

If a friend were in need of similar help, would you recommend my practice to them?

• Yes, definitely
• Yes, generally
• No, not really
• No, definitely not

If you were to seek help again, would you come back to my practice?

• Yes, definitely
• Yes, generally
• No, not really
• No, definitely not

Overall, how satisfied are you with my professional counseling?

• Very Satisfied
• Mostly Satisfied
• Mildly dissatisfied
• Quite dissatisfied

What did you like best about your counseling experience?

How might I improve to better serve client’s needs?

Other comments?

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