Your Name (optional):

Email to contact you for follow up if needed:

Your Therapist’s Name: 

Estimated Length of Time Since You Started Therapy With Us:

My therapist works with me in a professional manner.

My therapist starts and ends sessions on time.

My therapist is able to help me with the concerns which brought me to therapy.

The concerns which brought me to therapy have improved as a result of the services offered.

My therapist focuses on what is important to me.

My therapist includes me in decision making about my treatment.

My therapist treats me with dignity and respect.

My therapist listens to me

My therapist provides reading material, community resources, and referrals to other services when needed.

I feel emotionally safe with my therapist.

I believe that my therapist could be helpful to other clients.

My therapist is responsive to my questions.

My therapist and I are allowed to disagree on something.

I feel that services offered are inclusive and respectful of my identity (i.e. culture, race, ethnicity, religion, gender, sexual orientation, etc.)

The office space is appropriate for my needs.

I have a deeper understanding of trauma/adversity and its impact on me

My past trauma/adversity no longer impacts me in the way that it used to before therapy.

I have grown from trauma/adversity as a result of therapy.

1.     Which aspects of therapy are working and why?

2.     How could your experience with your therapist and the Phoenix Center be improved?

3.     What are 3 adjectives to describe your therapist are:

4.     Would you recommend your therapist to others? Why or why not?

5.     Would you recommend the Phoenix Center to others? Why or why not?

6.  Overall satisfaction with your therapist 

7.  Overall satisfaction with the Phoenix Center (please circle one):

Are you willing to consent to your answers to questions 4 and 5 being used anonymously on our website testimonial page? 

Additional Comments: