Client Satisfaction Survey

At this time, my counseling *

is still in progress

has been completed and I met most/all of my therapy goals

has ended, but I did not meet all of my therapy goals

Why did you end therapy (if applicable)?

Agreed with therapist that treatment was complete

Logistics, such as time commitment/scheduling, transportation, unsupportive family member

Unhappy with therapy process (i.e. brought up painful emotions)

Unhappy with therapist (i.e. not a good fit)

Finances

Other reason

Please complete the following survey questions:

1. I was treated considerately and respectfully by GBH staff.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

2. My counselor acted professionally.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

3. My counselor understood my problems and concerns.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

4. My counselor and I worked well together.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

5. I felt safe to talk about my issues in counseling.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

6. My counselor helped me to find my own solutions.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

7. I could have done more to make counseling more useful to me.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

8. My counselor could have done more to make counseling more useful for me.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

9. I am satisfied with the accomplishments that I made in counseling.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

10. My concerns that brought me to counseling have improved as a result of the services provided.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

11. What I have learned from coming to counseling has led to positive changes in my life.

Yes

No

12. I have learned one or more strategies to solve or cope with problems.

Yes

No

13. I have learned to think more clearly/accurately, to reduce distressing emotions or behaviors.

Yes

No

14. I have strengthened one or more self-management skills (example: managing time, stress)

Yes

No

15. I have made an important decision.

Yes

No

16. I have gained greater understanding or a clearer sense of identity.

Yes

No

17. I live a healthier lifestyle in at least one area.

Yes

No

18. I have improved my relationship with another person.

Yes

No

19. I have increased my ability to recognize, name, and/or appropriately express my emotions.

Yes

No

20. I have increased my self-confidence or self-esteem.

Yes

No

If needed in the future, would you come back to GBH?

Yes

Maybe

No

Would you recommend GBH to a close friend with personal problems?

Would highly recommend GBH

Would recommend GBH

Would recommend with some reservations

Would not recommend

Would advise against it

Name (Optional)

First Name

Last Name

Many people consider positive reviews when they are choosing a service provider. Your comments might help someone decide whether a GBH therapist is right for them. May we use your comments (anonymously!) in future promotional materials for GBH? (Website, social media, brochures, etc.)

GBH will never violate HIPAA privacy laws by sharing your personal or protected health information. Any survey comments used for testimonial purposes will be anonymous. We will NOT include client names or any other personal identifying information, if you chose to include your name on this survey. Clicking yes below does not guarantee that your comments will be used as a testimonial, but gives GBH the option of doing so.

Yes

No