Client Survey

Please correct the errors described below.

Hello! We are very interested in receiving your feedback on how we can improve your overall experience at 515 Therapy and Consulting. Please fill out our brief 10 question survey. The data received will come directly to Janel, HR and Operations Manager, and be used to enhance our clinical and administrative services. Please know your comments will not be shared outside of 515 Therapy and Consulting. If you are being treated by multiple providers at our practice, please fill out one form for each clinician.

Your Name (not required)

Your Provider's Name (this helps us provide feedback and support to 515's providers)

I feel that my provider understands me.

Strongly Disagree Disagree Neither Agree/Disagree Agree Strongly Agree

My provider is a warm, caring person.

Strongly Disagree Disagree Neither Agree/Disagree Agree Strongly Agree

We work on topics we both agree on.

Strongly Disagree Disagree Neither Agree/Disagree Agree Strongly Agree

The service I am receiving from this provider is helping me get better.

Strongly Disagree Disagree Neither Agree/Disagree Agree Strongly Agree

My provider is available, and I can schedule somewhat easily.

Strongly Disagree Disagree Neither Agree/Disagree Agree Strongly Agree

My provider has cancelled or rescheduled my session more than twice in the last six months.

Strongly Disagree Disagree Neither Agree/Disagree Agree Strongly Agree

I feel like my provider values my time and prioritizes my care.

Strongly Disagree Disagree Neither Agree/Disagree Agree Strongly Agree

My provider is communicative and engaged.

Strongly Disagree Disagree Neither Agree/Disagree Agree Strongly Agree

Please rate your overall relationship with your provider on a scale from 1-10.

1 2 3 4 5 6 7 8 9 10

How likely are you to recommend your provider at 515 Therapy & Consulting to a friend?

1 2 3 4 5 6 7 8 9 10

Any additional comments you’d like to share?

Thank you, we sincerely appreciate your feedback!

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