Feedback form 
Hello! This is Kristin Nakhla, Founder of Be Still Counseling and Wellness. I would love to hear your thoughts or feedback on how we can improve your overall experience with Be Still. Your comments will not be shared outside of Be Still and will not be posted online or elsewhere. I will use the data to improve areas of need with therapists and administration.

*Questions are adapted from Scott Miller's Session Rating Scale.
Sign in to Google to save your progress. Learn more
Your Name (not required)
Your Therapist's Name 
Please rate your sessions with your clinician.

I do/did not feel heard, understood, and respected.
I feel/felt heard, understood and respected.
Clear selection
Goals and topics in your sessions

We do/did not work on or talk about what I wanted to work on and talk about.
We work/worked on and talk/talked about what I wanted to work on and talk about.
Clear selection
Your therapist's approach or method
The therapist's approach is/was not a good fit for me.
The therapist's approach is/was a good fit for me.
Clear selection
Overall
Overall there's something missing in the sessions.
Overall our sessions are right for me.
Clear selection
How likely is it that you would recommend Be Still to a friend or colleague?
Not likely
Very likely
Clear selection
If below a 10, please let us know how we can improve.
How was your experience with scheduling an appointment at Be Still?
It was difficult to get in touch with and schedule an appointment with a therapist.
It was easy to get in touch with and schedule an appointment with a therapist.
Clear selection
If below a 10, please let us know how we can improve.
Do you have any feedback for us to make your experience or the experience of future clients better?
Would you like our Founder to reach out to you about this survey?
Clear selection
THANK YOU!
I sincerely appreciate your feedback and take every response seriously and use the information to improve clients' experience at Be Still. Thanks again!
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of bestillnc.com. Report Abuse
Google Forms