Client Feedback Form

My goal is to provide the highest quality care, and your feedback is invaluable in helping me improve. I truly appreciate your time and thoughtfulness in completing this form.

Name

First Name

Last Name

Date

YYYY

If you have not returned to therapy, please share the reason(s) why.

(You may select more than one option.)

I achieved my goals

Scheduling reasons

Financial reasons

My therapist wasn't a good fit for me

I didn’t feel the approach was the right fit for me

I prefer to take a break but may return in the future

Other

Testimonial

Positive feedback and testimonials are not only invaluable to my practice but can also offer reassurance to others who may be hesitant to reach out for support during a difficult time. Hearing about others' experiences can help them feel more comfortable taking that first step. If you’re willing to share a testimonial that may be shared in marketing materials, I would truly appreciate it. To maintain your confidentiality, only your words will be shared, with no identifying information.

Comments

Is there anything else you'd like to share? Please feel free to leave any further feedback here.

Client Feedback Form

Resilience Counseling Maine, LLC