Client Satisfaction Survey
Please take a few minutes to complete the survey. We value your feedback as we continue our quality improvement efforts. Thank you!
Client Name
First Name
Last Name
Therapist Name
First Name
Last Name
Email
example@example.com
My therapist made me feel comfortable in the session.
*
Strongly Agree
Agree
Neutral
Strongly Disagree
Disagree
My therapist is on time for sessions (telehealth and/or in-person)?
*
Strongly Agree
Agree
Neutral
Strongly Disagree
Disagree
How satisfied are you with the amount of help your therapist provides or provided?
*
Strongly Satisfied
Somewhat Satisfied
Neutral
Strongly Dissatisfied
Disatisfied
Therapy helps me deal more effectively with problems that arise.
*
Strongly Agree
Agree
Neutral
Strongly Disagree
Disagree
I receive a reminder of each of my appointments.
*
Strongly Agree
Agree
Neutral
Strongly Disagree
Disagree
What is your overall satisfaction with the scheduling process?
*
Strongly Satisfied
Somewhat Satisfied
Neutral
Strongly Dissatisfied
Dissatisfied
Did you feel welcomed at when visiting the clinic?
*
Yes
No
Never been to any of the clinic locations
What is your overall satisfaction with your therapist?
*
Strongly Satisfied
Somewhat Satisfied
Neutral
Strongly Dissatisfied
Dissatisfied
How long have you been seen by a therapist from AMRI COUNSELING SERVICES?
*
Less than 6 months
At lease 6 months but less than a year
At least 1 year but less than 2 years
At lease 2 years but less than 3 years
3 years or more
Based on my experience at AMRI Counseling Services, I would refer a friend or family member.
*
Strongly Agree
Agree
Neutral
Strongly Disagree
Disagree
In this final area, please add any comments not addressed in the survey that you think would be helpful.
*
Submit
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