Dr. Don G. Brock
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1. Client Satisfaction Survey
This survey provides vital feedback to Dr. Brock and the Relationship Clinic. This information will be used to improve counseling services. Please respond concerning your last counseling session, or the last few.
1
. I felt accepted by my therapist:
I felt accepted by my therapist:
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
2
. I believe my therapist liked me:
I believe my therapist liked me:
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
3
. I felt like my therapist understood my feelings:
I felt like my therapist understood my feelings:
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
4
. My therapist was honest and sincere:
My therapist was honest and sincere:
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
5
. My goals were important to my therapist:
My goals were important to my therapist:
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
6
. The sessions go smoothly and are comfortable for me:
The sessions go smoothly and are comfortable for me:
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
7
. My sessions go deep rather than talking on the surface:
My sessions go deep rather than talking on the surface:
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
8
. My sessions are helpful to my life:
My sessions are helpful to my life:
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
9
. My sessions give me hope for my future:
My sessions give me hope for my future:
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
10
. If you have any comments or suggestions, feel free to add them in the box below:
If you have any comments or suggestions, feel free to add them in the box below:
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