Client Feedback Form
Hello from Second Growth Counseling!  

We value your opinion and experience with us so much! We are always developing to improve our services and we would love to hear from you. We send out this form several times a year and this is an opportunity to share your thoughts and feedback about your experience. Your comments will not be shared outside of Second Growth Counseling and will not be posted online or elsewhere. This data is used to improve areas of need with our therapists, systems, and operations. *Estimated time to complete: 2-4 minutes!

*If you choose to share you name, it is kept confidential and NOT shared with your therapist.

We appreciate the opportunity to work with you! Thank you!
Sign in to Google to save your progress. Learn more
Your Therapist's Name: *
About how many sessions have you had with your therapist?
Clear selection
Please rate the following, based on your experience:
Your therapeutic relationship with your clinician:
I'm not feeling heard, understood, and respected.
I feel heard, understood, and respected.
Clear selection
Goals and topics in your sessions:
We are not addressing what I want to work on and talk about.
We do address what I want to work on and talk about.
Clear selection
Frequency of sessions:
I feel like we are not meeting enough.
I feel like we are meeting too often.
Clear selection
Your therapist's approach or method:
The therapist's approach is not a good fit for me.
The therapist's approach is a good fit for me.
Clear selection
Overall, how would you rate your experience of your sessions?
Something is missing for me.
Sessions are just right for me.
Clear selection
How would you describe your experience with your therapist? (What's going well? What do you like about your sessions? How are they helping you grow and make progress?)
Are you interested in switching therapists or getting on the waitlist for another particular therapist?
How was your experience with the following:
Unsatisfied
Neutral
Satisfied
Quality of telehealth (video) connection:
Meeting location (if you were in-person):
Sessions starting and ending on time:
Promptness of communication with therapist (email/text/calls):
Scheduling of sessions
Payments, billing, receipts, requested superbills:
Knowledge of office practices and policies:
Cancellation policy
Clear selection
How likely are you to:
Unlikely
Neutral
Likely
Return for additional appointments:
Recommend my therapist to others:
Recommend Second Growth Counseling to others:
Clear selection
Share your feedback on how we can make your experience or the experience of future clients better:
Would you like us to follow up with you? Please provide your name and preferred contact information. You can also reach out to us directly at info@secondgrowth.com or by phone/text at (503) 549-4714.  
Thank you!
We deeply appreciate your feedback and take every response seriously. Your voice and perspective matter to us. This information helps improve the client experience at Second Growth Counseling. Thank you again!
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Second Growth Counseling, LLC. Report Abuse
Google Forms