Client Satisfaction Form
Thank you for entrusting us with your emotional and mental wellness here at Inner Coach Counseling, LLC.

We want to hear from you because we value your feedback. The information that you provide will help us  measure how well we are doing and if we need improvement in our service delivery to the community.

Please fill this quick survey and let us know your thoughts. (your answers will be anonymous).
Email *
Overall, how pleased are you with your service and support at Inner Coach Counseling, LLC? *
Not at all
Extremely Pleased
How long have you been coming to Inner Coach Counseling, LLC? *
Required
How were you refered to Inner Coach Counseling, LLC? *
Required
If you used the internet to find us, what search keywords did you use? (ie, black, therapist, hypnotherapist, Atlanta, etc)
How satisfied are you with the following services? *
1 = Dissatisfied   5 = Extremely satisfied
1 Dissatified
2 Slightly Satisfied
3 Satisfied
4 Very Satisfied
5 Extremely Satisfied
N/A
Self scheduling
Appointment Scheduling
Reminder Emails
Reminder Calls
User friendly (Telehealth) Platform
Response Time
Billing Services and Supports
Fees and Charges
Online Therapy Option (Telehealth)
Website Information/navigation
Diversity in Providers
Social Media Resources
Immigration Assessments
Products
Other
Please provide helpful feedback about any of the services listed above.
Please indicate your interest level in the supports listed below.
Not Interested
Slightly Interested
Interested
Extremely interested
Support Groups for Men
Support Groups for Women
Support Groups for Couples
Grief Groups
Retreats
In-Person Sessions
Home Visits
Coaching (Life/Sucess/Executive)
Medication Management
Pre-Marital Counseling
Walk/Talk Therapy
Outdoor Activities
More Culturally Diverse Therapists
Programs for Veterans
Programs for Domestic/Intimate Partner Violence
Children Groups
Support to Parents
Support to Divorced Adults
Workshops
Live Events
Music/Art/Dance Therapy
Youtube Videos
Social Media Engagement
Co-Ed (male/female support groups)
Financial Workshops
Complimentary Healing Modalities (Reiki, Meditation, Crystal Healing, Breath Work, Chakra Alignment, etc)
LGBTQI+ friendly supports
Race/Cultural-Informed Practices
Other
Clear selection
What supports would you like to receive that you currently do not receive?
In your opinion, what is your therapists' most effective skill or characteristic? *
Required
In your opinion, what is the most effective therapeutic treatment modality used by your therapist? *
Required
Please provide specific details about the most effective treatment modality(ies) listed above? *
What would help make your therapy experience better? *
How confident are you in your therapist's ability? *
Not At All
Extremely
Would you recommend your therapist to a friend or family member? *
Would you recommend Inner Coach Counseling, LLC to a friend or family member? *
What is your therapist name? *
A LOVE LETTER aka Your Testimony
If you've ever written or received a love letter you know how special they are. Love letters are filled with warmth and gratitude; inspiring the receiver to keep doing what works. 

Everyone wants a love letter and we are no exception!
 
We would be honored if you could write a brief description of your positive experiences about how you were helped or supported (both big and small ways).

Why?  Because we want to know if what we are doing is working. 

For this reason, your testimony is super important to us and to potential consumers/clients -- showing us ways to improve and inspiring us to do good work in the world. 

By volunteering to offer a testimony, you agree to give us permission to use your 'love letter' on our website or other marketing materials/platforms; however we will protect your identity if requested. 

Please indicate how you would like your name signed after your testimony (ie, Last name and First initial, or your First name and Last initial, or Initials only, or Anonymous. Also include city and/or state). 

We truly appreciate your testimony ~ Love Letter!

{This is a judgement-free and pressure-free zone, so If you wish to not do so, please indicate below.}
*
We appreciate your feedback!   Remember that this information is anonymous and will only serve to help us to be more effective. Thank you!
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