Your experience matters to us greatly. We would appreciate your feedback on our services and performance. Please share your thoughts with us.

Feel free to submit this form anonymously by not signing into your Google account. However, if you prefer to identify yourself, please follow the instructions provided at the bottom of this form before clicking submit.

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Name of Clinician seen?
 *
I was able to schedule my appointment with my therapist in a timely manner *
My insurance benefits were explained to me in a way that made sense *
I was given clear directions to The Mental Wellness Center’s office *
I participated in developing my treatment goals *
I felt heard, seen, and understood during my therapy appointment *
We worked on and talked about what I wanted to work on and talk about *
I’m able to see my therapist as often as I would prefer *
The therapist’s approach is a good fit for me. *
I can see that I am making progress *
Additional Comments

If you prefer to stay anonymous, simply bypass this question and proceed to SUBMIT the survey. Should you wish for us to contact you for:

- Further discussion about your feedback,
- Or to arrange an appointment with a different clinician,

Kindly provide your client # or email address in the space below. We'll get in touch with you promptly.

To locate your Client #, log into our portal, select 'MY PROFILE', and then find it under the 'Personal Information' section. Copy and paste it here. If you don't have access to the portal, please enter your email address instead and then submit the form. We'll reach out to you as soon as possible. Thank you!

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This form was created inside of The Mental Wellness Center.