Therapist Feedback Form

Therapist Feedback Form

This will help us understand how our services have been helpful to you and what we can do better!
Please note this form is anonymous, unless you choose to insert your name information at the end.
What therapist did you work with?
What service did you receive?*
Please rate the following statement with respect to your involvement in counselling/psychotherapy services: Overall, I have been satisfied with my service.*

Strongly AgreeAgreeNeither agree or disagreeDisagreeStrongly Disagree
Please rate the following statement with respect to your involvement in counselling/psychotherapy services: Overall, I am satisfied with my progress.*

Strongly AgreeAgreeNeither agree or disagreeDisagreeStrongly Disagree
Please rate the following statement with respect to your involvement in counselling/psychotherapy services: Overall, I believe I have gained skills.*

Strongly AgreeAgreeNeither agree or disagreeDisagreeStrongly Disagree
Please rate the following statement with respect to your involvement in counselling/psychotherapy services: Overall, I believe I have a better understanding of myself.*

Strongly AgreeAgreeNeither agree or disagreeDisagreeStrongly Disagree
Please rate the following statement with respect to your involvement in counselling/psychotherapy services: Overall, I felt included in the service delivery.*

Strongly AgreeAgreeNeither agree or disagreeDisagreeStrongly Disagree
Please rate the following statement with respect to your involvement in counselling/psychotherapy services: I have felt my feedback has been respected by my therapist.*

Strongly AgreeAgreeNeither agree or disagreeDisagreeStrongly Disagree
What did you find most helpful about the services:*
What did you find could be more helpful about the services:*
Name- please note this is not required.

First NameLast Name
Have a complaint?

Please visit, https://www.stephaniefuller.ca/contact
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