Tell Us About Your First Visit
Your feedback about your first visit is incredibly important to us. At Kalamazoo Child and Family Counseling, we strive to create a welcoming and supportive environment where children and families receive high-quality behavioral and mental health care. Please take a moment to share your thoughts—we want to know how your first experience with us went.
Submitter's Name
*
First Name
*
Last Name
Submitter's Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Client's First and Last Name
First Name
Last Name
Did your first appointment at Kalamazoo Child and Family Counseling take place as scheduled?
*
Please Select
Yes
No
When was your intake appointment?
-
Month
-
Day
Year
Date
Name of Provider
Please Select
Aaron Begley
Aaron Henry
Ann Reinholt
Barbara Kimmel
Bobbie Smith
Carolyn Daniels-Krupp
Hannah Joseph
Jeffrey LaPonsie
Kathleen Morrill
Kendall Barry
Krista McQuillan
Larry (Lawrence) Stankus
Melanie Krieg
Michensey Hamlin
Tayler Dando
Overall, how satisfied were you with your intake?
Very Satisfied
Satisfied
Neutral
Unsatisfied
Very Unsatisfied
How long did you wait for your intake from your first call to KCFC?
0-7 days
2+ weeks
8-14 days
"I feel that the therapist I was matched with is a good fit based on my/my child's case."
Yes
No
Still Unsure
If your intake was a virtual appointment, did you face any technological obstacles to meeting with your therapist?
Yes
No
Did you schedule a follow-up appointment with your therapist?
Yes
No
In your own words, please describe anything positive or negative about your intake experience that you would like us to know:
Infusionsoft Tags
Active Client Marketing
DS Early Engage
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