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Client Satisfaction Survey
We appreciate your feedback!
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1
Your Name (Optional)
(Required, if you would like us to follow up with you.)
First Name
Last Name
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2
The Name of Your Therapist
*
This field is required.
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3
Overall Satisfaction
Please complete your evaluation of your therapy experience with us.
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Overall satisfaction
I felt heard, understood, and respected.
We worked on and talked about what I wanted to work on and talk about.
The therapist’s approach is a good fit for me.
Overall, the therapist was a good fit for me.
Were your counseling goals met?
Overall satisfaction
I felt heard, understood, and respected.
We worked on and talked about what I wanted to work on and talk about.
The therapist’s approach is a good fit for me.
Overall, the therapist was a good fit for me.
Were your counseling goals met?
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
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4
If you needed counseling in the future, would you return to Rum River Counseling?
YES
NO
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5
Would you recommend Rum River Counseling to someone who wanted counseling?
YES
NO
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6
What did you find MOST helpful about your therapist or your therapy experience at Rum River Counseling?
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7
What did you find LEAST helpful about your therapist or your therapy experience at Rum River Counseling?
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8
Additional comments or ideas on how to improve our services:
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9
Would you like us to follow up with you regarding any concerns?
YES
NO
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10
If yes, what is the best way to reach you?
Phone Call
Email
Either Phone Call or Email
Phone Call
Email
Either Phone Call or Email
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11
Email
example@example.com
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12
Phone Number
Area Code
Phone Number
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13
Please verify that you are human
*
This field is required.
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