Customer Feedback Survey for our Counselling and Therapy services
Thank you for your time to answer this feedback form. We wish to serve you and all our patients better. Your feedback is much appreciated.
Name : *
Your answer
Date of completion: *
MM
/
DD
/
YYYY
Your therapist *
Required
How do you rate your counsellor? *
Bad
Excellent
How do you rate the counselling room and it's environment?
Bad
Excellent
How do you rate your emotions and feelings after all the sessions?
Feel bad
Feel very relief and happy
How much do you think it has helped you in clearing your problems?
Not at all
Extremely helpful
How likely are you going to recommend our services to your friends and family?
Not likely
Most likely
Feel free to give any other comments on how we could improve this counselling service.
Your answer
Thank you for your time and effort. We appreciate your feedback and comments.
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