Changes Counseling Feedback Form

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Responses are collected anonymously and will not impact your treatment plan. Information from responses will be utilized to improve treatment services, provide training to office personnel, and improve accountability of therapists. Please be honest and open in your feedback.

My experience with office personnel has been: *

Extremely Negative

Extremely Positive

I have feedback regarding a specific office personnel. *

Ashley

Trichia

Meya

Inez

Talia

Dallana

Tarius

John

N/a

Other:

Required

Please provide feedback regarding the office personnel here.

My experience with therapists/group leaders has been: *

Extremely Negative

Extremely Positive

I have feedback regarding a specific therapist: *

Lincoln

Claire

Casey

Jeff

Holli

Chris

N/a

Other:

Required

Please provide feedback regarding the therapists here.

My experience with treatment content has been: *

Extremely Negative

Extremely Positive

I have feedback regarding specific therapy content. *

Thinking Errors

PRIME for Life

Anger Management Techniques

Drug & Alcohol Group Therapy

Domestic Violence Group Therapy

Individual/Family Therapy

Advanced Parenting Workshop

Moral Reconation Therapy

N/a

Required

Please provide feedback regarding therapy content here.

Please provide any additional feedback regarding your experience throughout treatment here.

If you would like to be contacted regarding your feedback, please provide your name and phone number below. Otherwise, note N/a. Thank you for your input. *

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