COUNSELING EXPERIENCE SURVEY Would you be willing to take a minute to give us your feedback? Question Title * 1. Where have you received your primary services and who has been your primary counselor? Main Office North Office Telehealth Choose your counselor Christina Danyele Deanna Heather Helen Mike Walker Intern Choose your counselor Main Office menu J.P.Mertens Tracy Waleska Intern Choose your counselor North Office menu Beth Samantha Choose your counselor Telehealth menu Question Title * 2. How would you rate your experience thus far? Excellent Good Okay Poor Question Title * 3. With 10 being greatest, how much benefit have you received personally from Rock Your Family Counseling? 0 5 10 Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 4. With 10 being greatest, if applicable how much benefit has your family received from our counseling services? 0 5 10 Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 5. Do you have any specific feedback for us? Question Title * 6. If you don't mind us contacting you regarding your feedback, please share any contact information you'd like. Thank you! Name Email Address Phone Number Submit
