Client Feedback Form

First Name

Last Name

Therapist's Name

My therapist listened to me effectively. My therapist listened to me effectively. Strongly Agree Somewhat Agree Neutral Somewhat Disagree Strongly Disagree

My therapist and I jointly developed a plan to address my concerns. My therapist and I jointly developed a plan to address my concerns. Strongly Agree Somewhat Agree Neutral Somewhat Disagree Strongly Disagree

My therapist focused on what was important to me. My therapist focused on what was important to me. Strongly Agree Somewhat Agree Neutral Somewhat Disagree Strongly Disagree

My therapist fostered a safe and trusting environment. My therapist fostered a safe and trusting environment. Strongly Agree Somewhat Agree Neutral Somewhat Disagree Strongly Disagree