LiveUp Counseling Client Care Survey

We ask that you take a few moments to provide us insight into your client experience at LiveUp Counseling utilizing this anonymous survey.

Thank you in advance for your time!

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* 1. What is your current status with LiveUp Counseling

Current Client

Past Client

Pending Client Referral

Other (please specify)

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* 2. Which location did you/do you attend services?

Lebanon

Harrisburg

York

Chambersburg

East Petersburg

Telehealth

Other (please specify)

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* 3. Who is/was your therapist?

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* 4. If you are no longer continuing or considering discontinuing services please provide us with feedback surrounding the factors contributing to your decision?

I had achieved my treatment goals

Scheduling Issues

Insurance Coverage Changed

Moved or Relocated

Didn't feel like a good fit with my clinician

Didn't feel treatment was helping

Personal or family issue

I am still attending session

Other (please specify)

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* 5. How would you rate your quality of care you received from your clinician?

Excellent

Good

Fair

Poor

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* 6. How would you describe your relationship with your clinician?

Very strong and supportive

Somewhat supportive

Neutral

Somewhat disconnected

Very Disconnected

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* 7. Did you feel heard, respected, and understood by your clinician?

Always

Usually

Sometimes

Rarely

Never

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* 8. Would you recommend your clinician to your friend or family member?

Yes

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* 9. What feedback would you have for your individual provider?

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* 10. Is there anything else we could do to improve your LiveUp Counseling Experience?

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* 11. Would you like to be contacted by one of our leadership at LiveUp Counseling to discuss your experience further?

Yes

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* 12. If you would like to be contacted to discuss further please provide your contact information.

Name

Date of Birth

Email Address

Phone Number