AMRI Counseling Services 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/ Clinician Name
First Name
Last Name
Email
example@example.com
I receive a reminder of my appointments.
*
Strongly Agree
Agree
Neutral
Strongly Disagree
Disagree
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 the scheduling process?
*
Strongly Satisfied
Somewhat Satisfied
Neutral
Strongly Dissatisfied
Dissatisfied
My therapist is on time for sessions (telehealth and/or in-person)?
*
Strongly Agree
Agree
Neutral
Strongly Disagree
Disagree
My therapist made me feel comfortable in the session.
*
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 believe I can reach my goals.
*
Strongly Agree
Agree
Neutral
Strongly Disagree
Disagree
I have positive people in my life who can help me reach my goals.
*
Strongly Agree
Agree
Neutral
Strongly Disagree
Disagree
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
Should be Empty: