How Are We Doing?
Hello! It is so important to us that all of our clients are receiving the highest level of attention and care. We would love to hear your thoughts and feedback as we are always looking for ways to improve your experience! Thank you for taking a few minutes to let us know how we can better serve you.
[Feedback is reviewed by Virginia Miller, owner of Southern Solace and our Client Coordinator.]
Sign in to Google to save your progress. Learn more
Your Name (or you can remain anonymous) 
Your Therapist
Clear selection
Relationship with your therapist
I do not feel understood
My therapist gets me and I think she's pretty cool, too!
Clear selection
Overall satisfaction with therapeutic process
What is this and why am I here? Yuck.
I'm pumped to be working on me!
Clear selection
How was your experience with administrative tasks such as paperwork, scheduling, payments, etc.?
I need therapy to deal with your practice policies
Smooth as butter
Clear selection
Have you noticed or experienced any concerns with our staff, your counselor, therapy process, procedures, etc.? We value your feedback as to how we can improve your experience at our practice.
Are there other services you would like for us to provide so you can get more wellness needs met under one roof?
If we were to offer workshops, which topics would you be interested in attending? These would not be group therapy...totally educational and skill building.
Any feedback on what we are doing well, and what else can be done to make our practice a welcoming, comforting and healing place?
How likely are you to refer Southern Solace to your colleagues or friends?
Heck No
I know they would be in good hands!
Clear selection
Thank you for your feedback. We appreciate you!
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Southern Solace Counseling. Report Abuse