Client Feedback Form

The Renew team is committed to providing you quality care within a compassionate Christian context.  Client feedback is needed to help us measure how well we are doing and give us guidelines to improve.  Please fill out the form below.  This form will be given to our Managing Partners.  If you would like someone to contact you, please note this in the section at the bottom of this form.  If you choose to remain anonymous, your comments will still be taken seriously.  Thank you for your assistance in helping Renew improve our services.

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Therapist Name *
Today's Date *
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How many sessions have you had so far? *
Required

The following questions are relative to your experience with your therapist and counseling session(s).

Use the following scale:  5=Strongly Agree  4=Agree  3=Disagree  2= Strongly Disagree  1=Not Applicable

I felt I was a partner in the therapy process.

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My concerns were listened to and understood.

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My therapist discussed what to expect from therapy.

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Prayer and/or Biblical principles have been used in therapy.

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Prayer and Scripture were used in a way that I found helpful.

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The counseling techniques used in therapy have been helpful.

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My therapist and I have clear, mutual goals for therapy.

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The issues I’m working on in therapy are getting better.

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My therapist responds to emails/phone calls promptly.

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My therapist is on time.

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I would refer others to my therapist.

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I would refer others to Renew.

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The following questions are relative to your experience with our online portal and administrative team.

Use the following scale:  5=Strongly Agree  4=Agree  3=Disagree  2= Strongly Disagree  1=Not Applicable

The online portal was easy to access.

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Registering to become a client was easy to do.

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I receive prompt responses when reaching out to the front desk or registration specialist.

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I am treated respectfully by the front desk team and registrations specialist.

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The office is clean and welcoming.  

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Are there any concerns regarding your clinical experience that we should be made aware of?  Your comments are used for growth opportunities only.

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Additional Comments: (If you would like to be contacted regarding this survey please include your name, contact information, and what you would like to discuss).

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