Anonymous Feedback Form

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Thank you for being here to provide feedback on your experiences with Intentions Therapy and services provided by myself, Dani Sullivan.

I deeply value the experiences you share here, and benefit from your perspective in refining my service offerings, and therapeutic approach.

You can complete this form at anytime: before, during, or after your time working with me.

This form is completely anonymous, and all fields are optional.

All responses (critiques, positives, and everything in between) will be carefully reviewed by Dani Sullivan and will be integrated into the therapeutic offerings, and practice management of Intentions Therapy.

Thank you for your feedback!

Name (leave blank if you would like your responses to remain anonymous)

How long have you been/were you a client?

Type of Service (select all that apply)

Individual Therapy

Individual Coaching

Relationship Coaching

Group Services

Professional Consultation

Educational Workshop

What would you like me to know about your experience working with me?

Please rate the therapeutic relationship

1 - I did not feel heard, understood or respected

3 - neutral

5 - I felt heard understood and respected

Clear selection

Please rate the goals and topics discussed

1 - We did not work on or talk about what I wanted to work on and talk about

3 - neutral

5 - We worked on and talked about what I wanted to work on and talk about

Clear selection

Please rate the clinician approach and method

1 - The clinician's approach was not a good fit for me

3 - neutral

5 - The clinician's approach was a good fit for me

Clear selection

Did you experience any micro-aggressions?

Would you recommend my services to a loved one? Please share your testimony.

Anything else you would like me to know?

Submit

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