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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!
1.
What is your current status with LiveUp Counseling
Current Client
Past Client
Pending Client Referral
Other (please specify)
2.
Which location did you/do you attend services?
Lebanon
Harrisburg
York
Chambersburg
East Petersburg
Telehealth
Other (please specify)
3.
Who is/was your therapist?
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)
5.
How would you rate your quality of care you received from your clinician?
Excellent
Good
Fair
Poor
6.
How would you describe your relationship with your clinician?
Very strong and supportive
Somewhat supportive
Neutral
Somewhat disconnected
Very Disconnected
7.
Did you feel heard, respected, and understood by your clinician?
Always
Usually
Sometimes
Rarely
Never
8.
Would you recommend your clinician to your friend or family member?
Yes
No
9.
What feedback would you have for your individual provider?
10.
Is there anything else we could do to improve your LiveUp Counseling Experience?
11.
Would you like to be contacted by one of our leadership at LiveUp Counseling to discuss your experience further?
Yes
No
12.
If you would like to be contacted to discuss further please provide your contact information.
Name
Date of Birth
Email Address
Phone Number
