Your Initials
First Name
Last Initial
Please share a testimonial about your work with your therapist:
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May we anonymously share your testimonial in our marketing channels? All therapy testimonials are anonymized for confidentiality.
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Yes
No
How would you rate our practice?
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Not good
Excellent
1 is Not good, 10 is Excellent
How would you rate your therapist, especially regarding therapy approach?
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Not good
Excellent
1 is Not good, 10 is Excellent
Do your expectations of therapy match your experience?
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Not at all
Yes, very much
1 is Not at all, 10 is Yes, very much
Did you meet the therapy goals you want?
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Not at all
Yes, Definitely
1 is Not at all, 10 is Yes, Definitely
Did you feel understood by your therapist?
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Not at all
Yes, Definitely
1 is Not at all, 10 is Yes, Definitely
How would you rate our administrative team?
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Terrible
Excellent
1 is Terrible, 10 is Excellent
If you have feedback for how our administration team can better support clients, please let us know how and what we could do better?
If you required support again, would you reconnect with our practice?
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No
Yes of course
1 is No, 10 is Yes of course
If you would not reconnect with our practice, can you please let us know why?
Is there anything else you would d like to share about your experience with Dream Life Out Loud?
Would you recommend our practice to a friends or family?
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No
Yes of course
1 is No, 10 is Yes of course
If you wouldn't recommend us to friends and family, can you please tell us why?
*This form is not encrypted, nor is it considered HIPAA secure. Please do not share personally identifiable information.
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