Clarity Therapist Monthly Survey

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Help Us, Help You - Therapist Monthly Check-In

Help Us, Help You - Therapist Monthly Check-In

This will take about 5 minutes to complete.

26Questions

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
3
How many *openings* do you have available?* This field is required.(i.e. you want to fill 5 more hours)
4
What is your weekly session goal?* This field is required.(e.g. 25 client hours)
5
How should we share your fee with clients?* This field is required.
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.Example: "Therapist's fees start at $225"
0/100
7
How should we share your fee range?* This field is required.Example: "Therapist's fees are $225-$275"
0/100
8
How should we explain your fee?* This field is required.Example: "Therapist's fee is $250"
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
$125-$175
$175-$225
$225-$275
$275-$325
$325-$350+
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
9am-5pm on weekdays
Before 9am on weekdays
After 5pm on weekdays
Weekends
No availability
12
The following topics/specialties have been trending the last few months. Please indicate any specialty area where you have experience.
STD Diagnosis
DID/OSDD
Health Anxiety
Domestic Abuse
Clients 55+
Suicidal Ideation
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?* This field is required.
YESNO
16
How many clients have recently ended therapy?* This field is required.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
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
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
Please share relevant information about the 4th 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
21
Please share relevant information about the 5th 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
22
Do we have your permission to follow up with these clients?* This field is required.Please share your insights that will help our efforts with follow up from client care.
23
Please select ALL of the pain points that you’re experiencingSkip this question if none apply to you
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
24
We want to make sure you feel supported in all areas at Clarity. Which areas would you like support in?* This field is required.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
Clinical concerns including conducting consultations, presenting my fee to clients, caseload growth, and complex cases
Admin and client support while I’m away
Other
25
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 a marketing support
Rose for matching/referral support
Logan for conversations about practice culture, practice development, and clinical support.
26
When we're aligned, you shine
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