Family Therapy Feedback Form

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Today’s Date *

YYYY

I felt heard and understood by my therapist. *

Strongly Disagree

Strongly Agree

My therapist seemed to hear and understand the members of my family. *

Strongly Disagree

Strongly Agree

I believe my therapist cares about me and my family. *

Strongly Disagree

Strongly Agree

My therapist believes in the future of our family. *

Strongly Disagree

Strongly Agree

I am hopeful we can achieve our therapy goals with this therapist. *

Strongly Disagree

Strongly Agree

We plan to continue therapy with this therapist. *

Strongly Disagree

Strongly Agree

I would recommend this therapist to someone seeking therapy. *

Strongly Disagree

Strongly Agree

What was the most helpful or most important part of this session? (optional)

What was the least helpful or least important part of this session? (optional)

Please use this space to share any thoughts you would like us to know.

Was this a remote session (via online or phone)?

Yes - video

Yes - phone

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For Telehealth Clients: Please use this space to offer any feedback about your therapist's audio, video or any other aspect of their environment, that can be improved. The angle of the camera? Sound quality? Background distractions? We really want to know how we can create a comfortable environment for you.

My First Name *

My Therapist's First Name *

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