Feedback / Exit Interview Thank you for taking the time to share your valuable feedback with us. Your input helps us better serve you and all of our clients. If you are a human and are seeing this field, please leave it blank. Please Rate Our Service 1 (Poor) - 10 (Outstanding) Making an appointment was easy: The wait time to be seen was reasonable: Insurance/billing was explained to me from the outset: No-show policies were made clear to me: The intake staff were courteous: Directions given and signage were clear: Please Rate Your Therapist 1 (Poor) - 10 (Outstanding) Respectful: Knowledgeable: Understanding: Had multicultural skills: Interested in my case: Responsive: Accessible: Able to answer my questions or concerns: Helpful in sharing effective coping skills: Developed a measurable treatment plan: Able to provide useful referrals: More Info I worked with the following staff: I was referred by: I came in seeking help for: I reached my therapeutic goals: YesNo The best part of my experience was: The worst part of my experience was: I would return again in the future: YesNo I would refer your practice to a friend: YesNo Comments: Personal Information (Optional) I would like to be contacted by a supervisor Name Phone Email Print This Page
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