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Bright Care Feedback Form
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Your Name (Optional)
Your answer
Therapist Name
To assist us with evaluating our therapists please provide the name of your therapist or feel free to decline.
Your answer
Overall, how would you rate the experience of your therapy at Bright Care Christian Counseling?
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1
2
3
4
5
N/A
I felt like I was safe, heard, and respected.
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Disagree
Neutral
Agree
N/A
The therapist's approach was a good fit for me.
*
Disagree
Neutral
Agree
N/A
I feel like therapy helped me feel less depressed, less anxious, less confused, or less unhappy.
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Disagree
Neutral
Agree
N/A
Was your treatment plan created and reviewed per your needs?
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Yes
No
Unsure | N/A
Did you meet your goals for services?
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Yes
No
Unsure | N/A
What would you like to have more of in therapy?
Your answer
What would you like to have less of in therapy?
Your answer
Something(s) I typically think about is/are
Your answer
How satisfied are you with prompt response to your email/call?
*
Unsatisfied
Neutral
Satisfied
N/A
How satisfied are you with scheduling an appointment?
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Unsatisfied
Neutral
Satisfied
N/A
How likely are you to return for another appointment?
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Unsatisfied
Neutral
Satisfied
N/A
How likely are you to recommend your therapist to others?
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Unlikely
Neutral
Likely
N/A
How likely are you to recommend Bright Care to others?
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Unlikely
Neutral
Likely
N/A
Additional Comments, Positive Feedback or Concerns, Questions, or Suggestions.
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