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100% of survey complete.

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* 1. Please provide your name and email address. Thank you. Please note: it is confidential and secure. You do not have to provide this information if you are uncomfortable. It can remain confidential.

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* 2. Date of Session:

Date

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* 3. Clinic Location

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* 4. This was my:

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* 5. My counselor is:

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* 6. Please answer based your experience of the reception  process

  Strongly Disagree Diagree Agree Strongly Agree N/A
The receptionist was warm and welcoming
The receptionist was friendly on the phone
The receptionist was helpful on the phone
The waiting room is inviting and welcoming
The receptionist worked with me to find therapy times that worked with my schedule
Overall, I am very satisfied with the reception I received at Stein Counseling

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* 7. All of us at Stein Counseling and Consulting Services want to do the best job we can. We want to know how we are doing and that means we want to know what YOU think. We would appreciate it if you would take a few minutes to read each question below and tell us how we are doing. Please be HONEST . . . we want to know what we do well and what we can do better so we can do our very best for you! Thank you.

  Strongly Disagree Diagree Agree Strongly Agree
I felt heard
I felt understood
I felt respected
I developed new insights
The therapist challenged me at the right moments on the right topics (when applicable)
We worked on what I wanted to work on
We talked about what I wanted to talk about
The therapist's approach is a good fit for me
Overall, today's session was right for me

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* 8. The session began on time

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* 9. The session ended on time

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* 10. Overall, how well did the SCCS Service Provider meet your expectations in the session?

  Poor Below Average Average Above Average
Professional
Knowledgable
Skillful
Communication

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* 11. Based on your session today:How likely are you to:

  Very Unlikely Unlikely Likely Very Likely
Want to Work with this provider again?
Recommend Stein Counseling Services to others?
Recommend this provider to other people?

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* 12. May we contact you with questions regarding your survey?

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* 13. Email Address

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