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* 1. My clinician is:

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* 2. Did your therapist help you achieve the purpose for which you sought counseling?

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* 3. Did your therapist help you obtain skills that will help you handle future problems?

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* 4. Did you therapist show interest in your needs?

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* 5. Did you therapist understand your needs?

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* 6. Did you therapist help you define your needs?

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* 7. Did you therapist involve you in the treatment planning (such as goals and frequency of visits)?

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* 8. Did you therapist respond to your requests for services?

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* 9. Are you going to continue treatment with this therapist?

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