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1. Please enter the name of your counselor:

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2. The front office staff greeted me in a positive and friendly manner.

  Strongly Agree Agree Disagree Strongly Disagree
Please Check One:

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3. The front office staff processed my arrival quickly so that I did not lose time from my session with my counselor.

  Strongly Agree Agree Disagree Strongly Disagree
Please Check One:

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4. My counselor listened to the reasons I sought counseling and, based on my input, we decided the goals for treatment together.

  Strongly Agree Agree Disagree Strongly Disagree
Please Check One:

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5. As a result of counseling, I am better able to manage my life.

  Strongly Agree Agree Disagree Strongly Disagree
Please Check One:

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6. Please select your Psychiatrist.

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7. The psychiatrist treated me with respect.

  Strongly Agree Agree Disagree Strongly Disagree N/A
Please Check One:

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8. The psychiatrist took my concerns into consideration and listened to me when prescribing medication.

  Strongly Agree Agree Disagree Strongly Disagree N/A
Please Check One:

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9. I am satisfied with the services I have received.

  Strongly Agree Agree Disagree Strongly Disagree
Please Check One:

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10. Comment Section

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