Client Satisfaction Survey

About Our Office

* Which office did you visit?
Rate the ease of scheduling your appointment.
Which of the following best describes your impression of our offices?
Which of the following best describes your experience(s) with our office staff?

About Your Therapist

Please select the name of your therapist
How many sessions have you attended?

Please tell us about your experience with your therapist:

My therapist understood my problems.
My therapist was competent and knowledgeable.
My therapist made it easy to talk about private things.
My therapist listened carefully to what I was saying.
My therapist had insight into my situation.
My therapist was respectful.

About Your Therapy

What is your overall satisfaction with your therapy at this time?

In no longer in treatment, please proceed to the next question.

When treatment ended, was your initial problem:
Why did you discount treatment? (please check all that apply)

If there is one thing that you could change to make your experience at Community Wellness Partners of NC better, what would it be?

About You

What is your gender?
How old are you?
I give permission for Community Wellness Partners of NC, PLLC, to use all or a portion of my comments in marketing materials, if they choose, without disclosing any identifying data.