Anonymous Feedback Questionnaire
Sometimes it can feel difficult to bring up concerns that you have about therapy, and I want you to have the best experience possible in our work together. I created this questionnaire to invite you to let me know what is going well and what you might want to be different, without the pressure of needing to bring it up on your own in session. Your answers are anonymous unless you choose to include your name below.
What is going well in therapy? What do you like about our work together? What would you not want to change?
What do you wish could be different in therapy? Is there anything that you find frustrating or confusing, or that you just don't like?
Are there any other thoughts that come to mind now, or things you have wanted to ask or say but haven't had the chance to bring up in session related to our work together?
Would you like me to bring up your feedback in one of our sessions so that we can discuss it? (This might be helpful if you have a concern or a question that you'd like a direct answer to.)
Yes (if you select this option, make sure to include your name below)
No
Optional: If you selected "Yes" in the question above, or otherwise would like me to have your name, please include it below. If you choose not to include your name here, this survey is completely anonymous and there is no way for me to connect you with your responses.
Submit
Should be Empty: