Brief Client Satisfaction Survey

Thank-you for filling out this speedy, client satisfaction survey about your experience at Cobb & Associates Inc..

It takes about 60 seconds or 22-clicks of your mouse to complete (if you don't provide any comments - more time if you add comments, which can be very helpful to us). You will not be asked to give any personally identifying information if you prefer not to do so. We do ask for your Case ID number but it is not required. Your Case ID number is located in the email you received that directed you to this survey. If you choose to provide your Case ID number, we can match your responses to your case which can help your therapist see your feedback in context. If you leave the Case ID number blank, then your responses will be anonymous and will viewed by your therapist as part of a general summary of findings only, with any names or identifying information in your comments removed.

Your feedback is much appreciated and will be used to improve our services in the future.

Please note that all fields followed by an asterisk must be filled in.
Nathan Cobb
Russ Millington
Diane Gibson
Erla Christens
Shezlina Haji
Male
Female
12-18
18-30
31-40
41-50
51-60
61+
Optional. Your Case ID number is shown in the email you received for this survey. Providing your Case ID number allows us to identify you but is not necessary if you do not wish to provide it.
With my partner for help primarily with marital/couple issues
By myself for help primarily with marital/couple issues
With my partner for help primarily with issues other than our relationship
By myself for help with personal issues (i.e. depression, stress, addiction, anxiety, etc.)
With other members of my family for help primarily with family-related problems (i.e. family conflict, parent-child relations, etc.)
By myself for help primarily with family-related problems (i.e. family conflict, parent-child relations, etc.)
1-3 Sessions
4-6 Sessions
More than 6 Sessions
0.0 No Improvement
0.5
1.0 Some Improvement
1.5
2.0 Moderate Improvement
2.5
3.0 Much Improvement
3.5
4.0 Mostly Resolved
4.5
5.0 Resolved
0.0 No Improvement
0.5
1.0 Some Improvement
1.5
2.0 Moderate Improvement
2.5
3.0 Much Improvement
3.5
4.0 Mostly Resolved
4.5
5.0 Resolved
For the next ten questions, please indicate how much you agree or disagree with each statement about your experience at Cobb & Associates Inc..

9. I felt supported and understood by the therapist.*
1 Strongly Disagree
2 Disagree
3 Partly Agree, Partly Disagree
4 Agree
5 Strongly Agree

Comments (Optional)
1 Strongly Disagree
2 Disagree
3 Partly Agree, Partly Disagree
4 Agree
5 Strongly Agree

Comments (Optional)
1 Strongly Disagree
2 Disagree
3 Partly Agree, Partly Disagree
4 Agree
5 Strongly Agree

Comments (Optional)
1 Strongly Disagree
2 Disagree
3 Partly Agree, Partly Disagree
4 Agree
5 Strongly Agree

Comments (Optional)
1 Strongly Disagree
2 Disagree
3 Partly Agree, Partly Disagree
4 Agree
5 Strongly Agree

Comments (Optional)
1 Strongly Disagree
2 Disagree
3 Partly Agree, Partly Disagree
4 Agree
5 Strongly Agree

Comments (Optional)
1 Strongly Disagree
2 Disagree
3 Partly Agree, Partly Disagree
4 Agree
5 Strongly Agree

Comments (Optional)
1 Strongly Disagree
2 Disagree
3 Partly Agree, Partly Disagree
4 Agree
5 Strongly Agree

Comments (Optional)
1 Strongly Disagree
2 Disagree
3 Partly Agree, Partly Disagree
4 Agree
5 Strongly Agree

Comments (Optional)
1 Strongly Disagree
2 Disagree
3 Partly Agree, Partly Disagree
4 Agree
5 Strongly Agree

Comments (Optional)
Yes, For Sure
Not Sure
No

Comments (Optional)
Yes, For Sure
Not Sure
No

Comments (Optional)
Resolved the problem(s) to my/our satisfaction
Felt much better and didn’t see a need to keep coming
Was referred by the therapist to a different resource who was a better fit for my/our concerns
I did not feel like there was a good fit between myself and the counsellor or the methods used in counselling
Did not feel counselling was really helping me (or us)
I/We could not afford to keep coming financially and/or my/our insurance coverage ended
Other commitments or pressures came up that made it difficult to focus on counselling
I was not ready for or committed to the process of seeking counselling
My partner (or I) decided to terminate the relationship (If couples counselling)
I would have kept coming but my partner did not want to come anymore (If couples counselling)
Other reason not listed here
Please feel free to elaborate here, if desired: