Client Feedback Form

At Whole Person Therapy, your feedback matters!

We value your opinion and we always want to improve our services. Our goals and priorities are guided by feedback and we appreciate the opportunity to work with you! Note: your answers are confidential and will not be shared with your therapist.

Thank you for your time and for being a part of the Whole Person Therapy Family!

Which clinician did you see? *

Was this your first session or are you an ongoing client?

Recently terminatedHad a consultation onlyCurrently a client

Overall, how would you rate your experience at Whole Person Therapy?

How satisfied are you with the following? *

	Satisfied	Neutral / NA	Unsatisfied
Scheduling
Prompt Communication
The Intake Experience
Insurance/ Superbills Were Communicated Clearly

How was the experience with your therapist? *

	Agree	Neutral	Disagree
My therapist listened to me
I felt respected and not judged by my therapist
My therapist helped me explored options and solutions
My therapist started session on time
My therapist ended session on time
My therapist did not cancel/reschedule often
I feel my clinician matches my needs
Explained practice policies/procedures well
My therapist understands me well
My therapist genuinely cares about me

How likely are you to? *

	Likely	Neutral	Unlikely
Return for an appointment
Recommend your therapist to others
Recommend Whole Person Therapy to others

If you didn't feel like your therapist was the best match for you, please email us at helencaldwell@ymail.com to let us know. We'll be happy to connect you with another therapist on our team or to refer you to some great colleagues in our community!

Any additional information or notes?

Would you like us to follow up about this feedback? If yes, please provide your name and preferred contact method.