Name of Staff or Therapist
Did you receive a call back for your first appointment within 24 hours?
Where the office staff professional and courteous?
How well did the counselor understand my problem / concerns?
Not at all
Did you and your counselor develop a safety plan together?
How frequently did you meet with your counselor on average?
Once a week
Twice a month
Less than Twice a month
Please share any additional feedback:
(Should you want us to contact you)
How would you like us to contact you?
No Response Needed
Should be Empty: