Please complete the following information. All information shared with Moreno Valley College Student Health & Psychological Services is strictly confidential and used for this office only.

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* 1. Name of your Therapist:

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* 2. Please select your age group:

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* 3. Please select your gender?

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* 4. Were you treated courteously by the staff?

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* 5. Were staff members attentive to your needs/problems?

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* 6. Did the therapist allow time to listen?

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* 7. Did the therapist spend enough time with you?

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* 8. Did the therapist understand your concerns or needs?

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* 9. Were you satisfied  with your session/sessions?

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* 10. How likely is it that you would recommend this service to a friend or colleague?

NOT AT ALL LIKELY
EXTREMELY LIKELY

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* 11. Do you have any other comments, questions, or concerns?

T