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Carbon County Counseling Center Client Satisfaction Survey
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* Indicates required question
What is your age?
*
0-10
11-17
18-30
31-50
51+
What is your gender?
*
Male
Female
Other:
What is your race/ethnicity?
*
Caucasian
Hispanic
African American
Native American/Alaskan Native
Asian/Pacific Islander
Prefer to not answer
Other:
What is your sexual orientation
*
Heterosexual/straight
Lesbian
Gay
Bisexual
Prefer to not answer
Other:
What is the primary program in which you were enrolled in?
*
Mental Health
Substance Abuse
Are you still attending services at Carbon County Counseling?
*
Yes
No
Was this your first time receiving services from Carbon County Counseling?
*
Yes
No
What services did you receive?
*
Evaluation
Individual Counseling
Group Counseling
DUI EducationClass
IOP/Substance Abuse
OP/Substance Abuse
Anger Management
Choices/Voices
Ohana House
Other:
Required
My primary counselor is/was...
*
Mayra Mendoza
Jennifer Webb
Richard Maners
William Maughan
Rebecca Goodman
Jared Schwab
Unsure
Other:
The reception staff was respectful
*
Not True
1
2
3
4
5
True
My individual counselor was respectful
*
Not True
1
2
3
4
5
True
The group counselors were respectful (skip if no groups were attended)
Not True
1
2
3
4
5
True
Clear selection
Other staff were respectful (skip if not applicable)
Not True
1
2
3
4
5
True
Clear selection
Did you create a personal treatment plan with your primary counselor?
*
Yes
No
Did you receive a copy of your treatment plan?
*
Yes
No
I did not want a copy
I felt heard , understood, and respected by my therapist.
*
Not True
1
2
3
4
5
True
My therapist and I worked on and talked about what I wanted to work on and talk about.
*
Not True
1
2
3
4
5
True
My therapist's approach was a good fit.
*
Not True
1
2
3
4
5
True
Overall, my therapist was right for me.
*
Not True
1
2
3
4
5
True
When I first came here, I:
*
Did not see any need to change
Was thinking about changing, but had not decided yet
Wanted to change and needed ideas how
Had already begun changing
Had finished most of my changes and needed support to maintain them
Other:
Since being here, I:
*
Still do not see any need for change
Am thinking about changing
Want to change and need some ideas how
Have begun making changes
Have made the changes that I need to and need support to maintain them
Other:
What I have learned from coming to the counseling Center has led to positive changes in my life.
*
Yes
No
I have learned one or more strategies to solve or cope with problems.
*
Yes
No
I learned to think more clearly/accurately to reduce distressing emotions or behaviors.
*
Yes
No
I've increased my ability to recognize, name, and/or appropriately express my emotions.
*
Yes
No
I've improved my self-confidence or self-esteem
*
Yes
No
What did you find most helpful about counseling?
*
Your answer
What did you find least helpful about counseling?
*
Your answer
If you could change anything about your counseling, what would it be?
*
Your answer
Were there services that you needed that weren't offered?
*
Your answer
If needed, would you come back to Carbon County Counseling?
*
Yes
No
Maybe
Would you recommend Carbon County Counseling to a close friend with personal problems?
*
Would highly recommend it
Would recommend it
Would recommend it with some reservations
Would not recommend it
Would advise against it
No Response
Please rate your overall experience with Carbon County Counseling.
*
Very Dissatisfied
1
2
3
4
5
6
7
8
9
10
Very Satisfied
Please write any additional comments.
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