OVERALL PROGRESS

Think of the problems or issues you wanted to resolve when you first came to counseling. Select below which best reflects how much improvement you feel you have made in resolving those concerns, thus far. *

Select below which best reflects the improvements you had expected to make in resolving those concerns, thus far. *

I will use the knowledge and resources provided to continue working toward my goals (if not already met). *

HELPFULNESS OF THE SESSION

On a scale of 1-10 rate how helpful have sessions been for you. (i.e. In terms of feeling heard and understood, creating a plan, fostering hope, understanding the issues better, being able to talk things out, getting unstuck, etc..) 1 Not Helpful --- 10 Very Helpful *

What was most helpful about the sessions for you? *

Was there anything that was unhelpful in sessions? (i.e. Were there topics you wanted to discuss but didn't, things you would like to change about the counseling process, approaches that might work better for you? etc..) *

CLIENT SATISFACTION SURVEY

Please indicate how much you agree or disagree with each statement. These statements have to do with your experience at your counseling sessions. On this scale, 1=strongly disagree and 5=strongly agree.

I gained new insights that changed my views on my situation for the better. *

I tried out new patterns of behavior in our sessions and between sessions that did help me *

I (or we) had clear goals for what I (or we) wanted to accomplish in counselling. *

Counselling helped me improve the quality of my life. (For couples or family therapy, please answer this statement instead): Counselling helped us improve the quality of our lives together.

I would come back to see the therapist again if the need arose.

Yes, For Sure

Not Sure

No

We'd love to share your experience! Would it be okay to use your feedback as a testimonial on our website and/or social media accounts?

Yes

No

Therapist's Name

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Jane Doe

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Jane Doe

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BMMHC Client Satisfaction Survey

BMMHC Client Satisfaction Survey

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"Lorem ipsum dolor sit amet, consectetur adipiscing elit. Quisque nec nulla viverra, vehicula erat ut, posuere mauris. Donec porttitor viverra arcu in porta. Ut et arcu viverra, imperdiet urna ut"

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