CLIENT SURVEY Customer Feedbacks Please take a few minutes to give us feedback about your experience at Solidminds "*" indicates required fields Step 1 of 4 25% Date* Genda* Male Female Prefer Not to Say Age Group* 12 or Younger 13 -18 19 – 24 25 – 40 40 – 50 50 – 60 60+ Approximate Number of Months in Therapy* Less than 1 1 – 3 3 – 6 6 – 9 9 – 12 Over 12 My first contact with Solid Minds was positive* Strongly Agree Agree Neutral Disagree Strongly Disagree I felt Solidminds responded to my need in a timely manner* Strongly Agree Agree Neutral Disagree Strongly Disagree Appointment and scheduling procedures were clearly communicated* Strongly Agree Agree Neutral Disagree Strongly Disagree My counselor listened and understood the concerns I brought to counseling* Strongly Agree Agree Neutral Disagree Strongly Disagree My counselor helped me develop better ways of coping with the problems, feelings or situation that brought me to Solid Minds.* Strongly Agree Agree Neutral Disagree Strongly Disagree I trust that my counselor will maintain my confidentiality* Strongly Agree Agree Neutral Disagree Strongly Disagree I would refer friends to Solid Minds* Strongly Agree Agree Neutral Disagree Strongly Disagree I would return for counseling if I felt the need* Strongly Agree Agree Neutral Disagree Strongly Disagree My experience at Solid Minds has positively affected my life* Strongly Agree Agree Neutral Disagree Strongly Disagree Please rate the overall level of distress that brought you to counseling ** Strongly Agree Agree Neutral Disagree Strongly Disagree Please include any other comments you would like to add about your experience at Solid Minds Name First Last Therapist's Name*May we use your comments (without your name or any identifying information) in our printed materials and website? Yes No CAPTCHA
