Client Feedback Form
Your feedback matters to us! Please take a few moments to let us know about your experience at SLC, provide your insight on how we can continue to grow, or recognize a member of our team.
Overall Experience
Please rate your overall experience at Silver Linings Counseling
Administrative staff
Very unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
Billing process
Very unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
Office environment
Very unsatisfied
Unsatisfied
Neutral/NA
Satisfied
Very Satisfied
Office Cleanliness
Very unsatisfied
Unsatisfied
Neutral/NA
Satisfied
Very Satisfied
Telehealth Experience
Very unsatisfied
Unsatisfied
Neutral/NA
Satisfied
Very Satisfied
Ease of scheduling
Very unsatisfied
Unsatisfied
Neutral/NA
Satisfied
Very Satisfied
Overall SLC experience
Very unsatisfied
Unsatisfied
Neutral/NA
Satisfied
Very Satisfied
Would you recommend SLC to others?
No
Maybe
Yes
Please explain why you would not recommend SLC to others:
This information will remain confidential unless you choose otherwise.
Therapist Experience
Please rate your experience with your therapist
Overall therapist experience
Very unsatisfied
Unsatisfied
Neutral/NA
Satisfied
Very Satisfied
Respect felt by therapist
Very unsatisfied
Unsatisfied
Neutral/NA
Satisfied
Very Satisfied
Therapist understanding
Very unsatisfied
Unsatisfied
Neutral/NA
Satisfied
Very Satisfied
Therapist helpfulness
Very unsatisfied
Unsatisfied
Neutral/NA
Satisfied
Very Satisfied
Would you recommend your therapist to others?
No
Maybe
Yes
Please explain why you would not recommend your therapist to others:
This information will remain confidential unless you choose otherwise.
Additional Feedback
Please select one:
I am a current client
I am a parent/guardian of a current client
I am a client discontinuing services
I am a parent/guardian of a client discontinuing services
I am a former client
Reason for discontinuing services:
I met my goals
I moved
My insurance changed
I was dissatisfied with SLC and/or my therapist
Other
If your insurance hadn't changed, would you have stayed with your current therapist?
Yes
No
Would you like to discuss a reduced private pay rate to stay with your therapist?
Yes
No
Please provide details so that we can inform our management team
Do you have any suggestions, comments, or concerns regarding SLC or your therapist?
Would you like follow-up communication from a manager?
Yes
No
Would you like your feedback shared with the therapist?
Yes
No
Name
Therapist
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
Should be Empty: