You have completed therapy...we invite your feedback about your experience.

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Thank you for taking the time to share your experience so we can continue to strive towards excellence when serving our clients.

Today’s Date *

YYYY

What is your first name? *

Which IRTC Therapist did you work with?

Laura

Jonathan (JT)

Jessie

Elin

Natasha

Ryan

Brianna

Judith

Jana

Frances

Other:

Was this your first therapy experience?

Yes

Other:

Clear selection

Did you attend Individual, Couples, Relationship or Family Therapy at IRTC?

Individual Therapy

Couples Therapy

Family Therapy

Relationship (other than listed above)

Other:

Approximately how many sessions did you attend?

1-3 sessions

4-6 sessions

7-10 sessions

11+ sessions

Other:

Why did you discontinue therapy?

I/we reached our goals and were ready to end therapy.

I/we were feeling better and decided to 'try life without therapy'

I/We weren't making progress.

My/our financial situation changed and we needed to take a break from therapy.

I/we didn't feel a connection with our therapist.

I/we decided our therapist wasn't a good fit for us.

Therapy wasn't what we expected

Other:

Every client begins their therapy process at IRTC with a complimentary phone consultation with our Client Engagement Specialist, Michel. It was during this call that you were connected with a therapist, informed of fees, discussed scheduling. Was this a helpful part of your therapy process?

Yes

I don't remember

Other:

Clear selection

Were your questions or concerns adequately addressed?

Yes

Clear selection

Please provide any feedback about your experience during the initial call.

Do you believe you were 'paired' with the therapist who best suited your needs?

Yes

Other:

Please use this space to offer feedback regarding whether or not you feel you were paired with the right therapist for you and your needs.

Would you recommend this therapist to a friend or family member?

Yes

Maybe

Clear selection

If No or Maybe, please explain.

Please use this space to describe your experience and how you feel your therapists did/did not help you/your relationship during your time in therapy.

Please use this space to offer additional feedback that can help our therapists continue to learn and improve their services.

Is it ok to share your feedback with your clinician?

Yes, please share my feedback directly with the therapist.

No, I prefer you do not share my feedback directly with the therapist.

Please feel free to share my feedback with the therapist however I prefer my identity not be revealed.

Other:

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