6-12 Month Post Therapy Survey Please enable JavaScript in your browser to complete this form.Your Name *Your therapist's name: *Kristin BellKristen DundeeJill ObbagyBrenna PanerasAndrea PriceDo you remember why you started services? *Yes, entirelySomewhatNo, not at allHow are you doing today? *No problems or no symptomsMild problems or mild symptomsModerate problems or moderate symptomsSevere problems or severe symptomsSince ending services, how have your problems/symptoms changed? *They have become completely betterThey have become moderately betterThey have become mildly betterThey have not changed at allThey have become mildly worseThey have become moderately worseThey have become alot worseIf you have been feeling the same or worse, please check all of the reasons that applyI'm not surebecause stress in my life has become worseI want to work on my problems/symptoms but I don't have the motivation to do itI want to work on my problems/symptoms but I don't think anything will helpI have tried everything I can think of, but nothing seems to helpIf there are any other reasons not listed above, please list them belowIf things have gotten better since ending services, please check all the reasons why: *I don't know why things have gotten betterThe stress in my life has improvedI have ontinued to follow the advice of my therapistI have tried otherthings to help me with my problems/symptomsCheck all that applyIf you have tried other things to help you work through problems/symptoms, please check all that apply:I tried prescription medicationI have tried over the counter medications (like SAMe, St. John's Wort, Fish Oils, etc...)I tried group therapyI tried a support groupI tried talking with a friend or family member more in depthI tried ignoring the problems/symptoms altogetherI tried another therapistCheck all that applyPlease rate your therapist on the scale below *Very Good, I would highly recommend this therapistGood, I would recommend this therapistFair, I may or may not think of recommending this therapistPoor, I would not recommend this therapistVery Poor, I would discourage people from seeing this therapistPlease use the space below to add any comments about what you liked or disliked about your experience with your therapist or with the group practiceTo what degree do you believe that depression or anxiety are caused by a "chemical imbalance"?Not at allA littleMostlyCompletelyI have no idea or opinion on thisPhoneSubmit
