Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
heart2heart Client Feedback Form
Your assistance in completing this form is greatly appreciated. Honest feedback will help us serve you better and enable us to improve our service to more fully meet your needs.
Thank you for sharing your comments which are vital to this program.
Cathy Brooksie Edwards, Clinical Director
Sign in to Google
to save your progress.
Learn more
Date
MM
/
DD
/
YYYY
Name
Your answer
Practitioners
Your answer
How did you feel about the session?
Your answer
How did you feel before the session?
Terrible
1
2
3
4
5
6
7
8
9
10
Terrific!
Clear selection
How did you feel after the session?
Terrible
1
2
3
4
5
6
7
8
9
10
Terrific!
Clear selection
What modalities did you find most helpful? Check all that apply.
Hands-on healing
Energy work
Singing/Chanting
Instrumentation
Verbal guidance
Holding Silence
Other:
Tell us about the overall atmosphere. Did you feel safe and relaxed?
Yes
No
Clear selection
Did you feel listened to and understood?
Yes
No
Clear selection
Did you feel like you could express fully?
Yes
No
Clear selection
Did the session begin and end on time?
Yes
No
Clear selection
Is there any other information that you can share about your experience; i.e., thoughts, feelings, visions, likes and dislikes
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
