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Brave Hope Counseling Client Feedback Form

Thank you for taking a couple of minutes to complete this feedback form. We value your feedback!

The information provided on this form is confidential and will only be reviewed by the Brave Hope Counseling Director of Business Operations and Owner. It will not be shared with your clinician, unless you give us permission at the end of this form to do so.

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Today's Date
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About Me *
My clinician listens to me effectively.
Clear selection
My clinician demonstrates to me that they understand things from my own point of view.
Clear selection
My clinician focuses our sessions on what is important to me.
Clear selection
My clinician consistently listens to what I am saying without judging me.
Clear selection
My clinician consistently shows warmth towards me.
Clear selection
My clinician fosters a safe and trusting environment.
Clear selection
My clinician begins and finishes all our sessions on time.
Clear selection
My clinician is able to follow my lead during our sessions whenever it is appropriate.
Clear selection
My clinician provides practical guidance throughout our sessions, when or if it is appropriate.  
Clear selection
My clinician's approach has been a good fit for me so far.
Clear selection
My clinician has helped me identify my goals.
Clear selection
My clinician has helped me reach my goals.
Clear selection
Based on my experience, I would recommend others to work with my clinician.
Clear selection
Based on my experience, the overall service provided by my BHC clinician is excellent.
Clear selection
Based on my experience, scheduling my first appointment with BHC's Client Care Coordinator was excellent.
Clear selection
Based on my experience, BHC's Billing Department was able to answer my questions and provide me with excellent service.
Clear selection
Based on my experience, I would recommend others to Brave Hope Counseling.
Clear selection
What else would you like us to know about your experience with Brave Hope Counseling that would help us to make it more comfortable and/or helpful for you and others? *
We are a new growing business and would love any negative feedback you are willing to share. 
We are a new growing business and would love any positive feedback you are willing to share.
I give my permission to use my feedback on the Brave Hope Counseling website. (My identity will stay anonymous) *
I give my permission to share my feedback with my clinician.  *
Can our COO or Founder contact you to follow up with any concerns you have expressed on this form? *
If you selected YES above, please provide your Contact Information (Name, Phone Number, Email) 
If you selected NO above, please type N/A
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