* 1. I have been treated with courtesy and respect

* 2. I am satisfied with the care I have received.

* 3. I am satisfied with the speed my sessions have been scheduled and which my phone calls have been returned.

* 4. I was included in decisions related to my therapy goals

* 5. I found that therapy has been helpful to me.

* 6. If I needed help in the future, I would feel comfortable calling this therapist again.

* 7. Please give any feedback you would like regarding your service or what might be improved