Post Therapy Satisfaction Survey Please enable JavaScript in your browser to complete this form.Your Therapists NameKristin BellKristen DundeeJill ObbagyBrenna PanerasAndrea PriceYour Name * (only required if you would like us to follow up with you)Phone Number * (only required if you would like us to follow up with you)Email Address* (only required if you would like us to follow up with you)I felt respected and understood *None to very little (0-24%)Somewhat (25-50%)More than not (51-74%)A lot (75-90%)Entirely (91-100%)I was honest with my therapist *None to very little (0-24%)Somewhat (25-50%)More then not (51-74%)A lot (75-90%Entirely (91-100%)I agreed with my therapist's advice *None to very little (0-24%)Somewhat (25-50%)More than not (51-74%)A lot (75-90%)Entirely (91-100%)I followed my therapist's recommendations *None to very little (0-24%)Somewhat (25-50%)More than not (51-74%)A lot (75-90%)Entirely (91-100%)My therapist seemed uncaring *None to very little (0-24%)Somewhat (25-50%)More than not (51-74%)A lot (75-90%)Entirely (91-100%)My therapist seemed aloof and distant *None to very little (0-24%)Somewhat (25-50%)More than not (51-74%)A lot (75-90%)Entirely (91-100%)My therapist did not offer feedback or other recommendations *None to very little (0-24%)Somewhat (25-50%)More than not (51-74%)A lot (75-90%)Entirely (91-100%)I benefited from therapy *None to very little (0-24%)Somewhat (25-50%)More than not (51-74%)A lot (75-90%)Entirely (91-100%)I would recommend my therapist to friends or family *None to very little (0-24%)Somewhat (25-50%)More than not (51-74%)A lot (75-90%)Entirely (91-100%)Other comments or suggestions(not required)Please rate the office location *ExcellentGoodFairPoorPlease rate the professionalism of the office *ExcellentGoodFairPoorPlease rate the billing and financing for the office *ExcellentGoodFairPoorPlease rate the time it took for your first call and first appointment *ExcellentGoodFairPoorPlease rate your time spent in the waiting roomExcellentGoodFairPoorOther suggestions or explaination of response abovePlease rate your therapist on the following scale *My therapist EXCEEDED my expectationsMy therapist met ALL of my expectationsMy therapist met MOST of my expectationsMy therapist met SOME of my expectationsMy therapist met NONE of my expectationsPlease explain the rating of your therapist rating above(Not required)How much do you agree with the following statement: "I found therapy to be helpful." *Completely trueMostly trueSomewhat trueNot true at allIf you responded "Not true at all", please explain why you answered that wayPlease let us know what you think we could do to improve our practice and/or services:EmailSubmit
