Clarity Therapist Monthly Survey

1
What's your name?* This field is required.
2
Has your information regarding the number of openings, fee communication, desired fee ranges, session formats, and available time slots remained unchanged since last month?* This field is required.
Yes, my information has remained unchanged
No, I need to update my information and/or this is my first time completing the HUHY survey or I need to re-open myself for matching
3
How many weekly *openings* do you have available?* This field is required.(i.e. you want to fill 5 more hours)
4
What is your total weekly session goal?(e.g. 25 client hours)
5
How should we share your fee with clients?
Range (ex: $225-$275)
Flat rate (ex: $250)
Entry rate (ex: starts at $225)
6
How should we share your *starting* fee?* This field is required.Examples: "Therapist's fees start at $225" "Therapist's fees start at $225 with limited sliding scale slots available". (We can remove the sliding scale portion when a client indicates being able to pay a fee within your range.)
0/100
7
How should we share your fee range?* This field is required.Example: "Therapist's fees are $225-$275" "Therapist's fees are $225-$275 with limited sliding scale slots available". (We can remove the sliding scale portion when a client indicates being able to pay a fee within your range.)
0/100
8
How should we explain your fee?* This field is required.Examples: "Therapist's fee is $250" "Therapist's fee is $250/session with limited sliding scale slots available". (We can remove the sliding scale portion when a client indicates being able to pay a fee within your range.)
9
On the matching questionnaire, clients indicate the fee ranges they’re comfortable paying. Select ALL of the fee ranges you're comfortable receiving.* This field is required.Please select all that apply. We'll always share what you indicate as your fee (range). Being open to a wider range increases the number of referrals we can send your way.
$150-$200
$200-$250
$250-$300
$300-$350
$350 and above
10
Which session format are you able to provide (and prefer to offer)?* This field is required.Please select all that apply
In-person sessions in our NYC office
Virtual/Telehealth
Hybrid
11
Which time slots are you looking to fill?* This field is required.Please select all that apply. Note: Recently we have had limited therapists available after 5pm or on weekends with a large number of requests for these days/times.
9am-5pm on weekdays
Before 9am on weekdays
After 5pm on weekdays
Weekends
No availability
12
These topics have been trending. Please indicate any area you have experience or specialize in.
Agoraphobia
Women's Health
Men's Issues
Other
13
How would you describe your current caseload?* This field is required.
My caseload is full and I'm content
I have a few slots to fill, but I’m being selective
I'm struggling with maintaining my current caseload
I need many more clients to reach my goals
14
What feedback have you received during recent consultations from clients that may be helpful for us to know?
15
Have any clients terminated or stopped showing up for therapy over the past month?
YESNO
16
How many clients have recently ended therapy?This includes clients who achieved their treatment goals, as well as those who simply stopped coming.
17
Please share relevant information about the 1st client who recently ended therapyThis form is HIPAA compliant, so you can securely and ethically share client names
Please enter the name of the client as it appears in Simple Practice
Feel free to share any additional information that may be helpful for us to know
18
Please share relevant information about the 2nd client who recently ended therapyThis form is HIPAA compliant, so you can securely and ethically share client names
Please enter the name of the client as it appears in Simple Practice
Stopped showing/I'm not sure
Stopped showing/I'm not sure
Client moved out of state
Seeking higher level of care
Seeking specific modality I don’t offer (i.e. EMDR)
Client achieved their goals
Financial reasons
Scheduling conflicts
Not making progress in therapy
Prefer in-network provider
Personal reasons (not specified)
Why did the client end treatment? Select as many reasons as necessary.
Feel free to share any additional information that may be helpful for us to know
19
Please share relevant information about the 3rd client who recently ended therapyThis form is HIPAA compliant, so you can securely and ethically share client names
Please enter the name of the client as it appears in Simple Practice
Stopped showing/I'm not sure
Stopped showing/I'm not sure
Client moved out of state
Seeking higher level of care
Seeking specific modality I don’t offer (i.e. EMDR)
Client achieved their goals
Financial reasons
Scheduling conflicts
Not making progress in therapy
Prefer in-network provider
Personal reasons (not specified)
Why did the client end treatment? Select as many reasons as necessary.
Feel free to share any additional information that may be helpful for us to know
20
Do we have your permission to follow up with these clients?Please share your insights that will help our efforts with follow up from client care.
21
Please select ALL of the pain points that you’re experiencingSkip this question if none apply to you
No current pain points
I follow up with clients but rarely hear back
I’m receiving matches but few clients book consults
I occasionally have trouble following up with clients as quickly as I'd like
I’m struggling to make referrals within our group
I’d like to receive more referrals within our group
I’m receiving fewer matches
Clients I consult with seem to be looking for in-network providers
My fees don’t seem to align with what clients are looking for
Other
22
We want to make sure you feel supported in all areas at Clarity. Which areas would you like support in?Check all that apply
I don’t have any concerns at this time
Client billing and payment issues
Matching, client referrals, and growing my caseload
Marketing including blog writing, HARO guidance, and increasing my online visibility
Profile photo feedback/consultation
I'd like to give a Clarity Chat
I'd like to learn more about online endorsements
Clinical concerns including conducting consultations, presenting my fee to clients, caseload growth, and complex cases
Admin and client support while I’m away
Other
23
I'd like to request a meeting with...We recommend connecting with our team to better understand how we can support you. Please select the following support options you’d like to explore:
Dana for administrative support
Lauren for marketing support
Rose for matching/referral support
Logan for conversations about the practice and clinical support.
I don't need to request a meeting at this time
Other
24
When we're aligned, you shine
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