Client Feedback Form
Insight Counseling & Therapy's staff is interested in your experience with our facility. It would be helpful if you would answer this brief, anonymous questionnaire so we can have an assessment of the quality of your counseling experience.
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Clinician Name *
Date *
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Gender
Clear selection
Do you have previous experience with counseling? *
What were your main concerns for which you sought counseling? *
Awareness: The sessions helped you understand the issue, opportunity, or problem more fully. *
Strongly Agree
Strongly Disagree
Awareness: The clinician listened to you. You felt heard. *
Strongly Agree
Strongly Disagree
Knowledge: You gained a better understanding of yourself. *
Strongly Agree
Strongly Disagree
Knowledge: You learned about different ways to address your issue, opportunity, or problem. *
Strongly Agree
Strongly Disagree
Skills: This clinician helped you identify specific strengths and resources to help you work through your concerns and issues. *
Strongly Agree
Strongly Disagree
Counseling has helped me be successful in... *
Required
Skills: You will take action and do something in terms of changing your thinking, feeling, or behavior after these sessions. *
Strongly Agree
Strongly Disagree
I would refer a friend or family member to Insight Counseling and Therapy. *
Overall, I am satisfied with the quality of counseling I have received.
Clear selection
If you have completed your counseling: Your counselor prepared you for termination of counseling. *
Strongly Agree
Strongly Disagree
I would not hesitate to return for counseling if I needed it. *
Strongly Agree
Strongly Disagree
What did you find helpful? What did the clinician do that was right? Please be specific. For example: Not, "You did great," but rather, "You listened to me carefully when I talked about ____."
What, if anything did the clinican miss that you would have liked to explore today or in another session? What might you have liked to have happen that didn't?
Use this space for additional comments or suggestions on how we can improve Insight Counseling and Therapy.
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