Brief Client Satisfaction Survey

Thank-you for filling out this speedy, client satisfaction survey about your counselling experience.

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.

GDPR*

	I am at least 16 years of age.
	I have read and accept the privacy policy.
	I understand that you will use my information to contact me or send me the information I requested.

1. Therapist's Name*

	Nathan Cobb
	Russ Millington
	Diane Gibson
	Erla Christens
	Shezlina Haji

2. Gender*

	Male
	Female

3. Age*

	12-18
	18-30
	31-40
	41-50
	51-60
	61+

4. Case ID Number.
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.

5. I came to counselling:*

	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.)

6. I came for (approximately):*

	1-3 Sessions
	4-6 Sessions
	More than 6 Sessions

7. Think of the problems or issues you wanted to resolve when you first came to counselling. Select a number below that best reflects how much improvement you made in resolving those concerns.*

	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

8. Select a number below that best reflects the improvements you had expected to make in resolving those concerns.

	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)

10. The therapist's approach or style was a good fit for me.*

	1 Strongly Disagree
	2 Disagree
	3 Partly Agree, Partly Disagree
	4 Agree
	5 Strongly Agree

Comments (Optional)

11. Things I learned in counselling helped me to make positive changes.*

	1 Strongly Disagree
	2 Disagree
	3 Partly Agree, Partly Disagree
	4 Agree
	5 Strongly Agree

Comments (Optional)

12. I gained new insights that changed my views on my situation for the better.*

	1 Strongly Disagree
	2 Disagree
	3 Partly Agree, Partly Disagree
	4 Agree
	5 Strongly Agree

Comments (Optional)

13. I tried out new patterns of behavior that helped me, either in our sessions or outside of our sessions.*

	1 Strongly Disagree
	2 Disagree
	3 Partly Agree, Partly Disagree
	4 Agree
	5 Strongly Agree

Comments (Optional)

14. In our sessions we covered what was important to me.*

	1 Strongly Disagree
	2 Disagree
	3 Partly Agree, Partly Disagree
	4 Agree
	5 Strongly Agree

Comments (Optional)

15. I (or we) had clear goals for what I (or we) wanted to accomplish in counselling.*

	1 Strongly Disagree
	2 Disagree
	3 Partly Agree, Partly Disagree
	4 Agree
	5 Strongly Agree

Comments (Optional)

16. I (or we) made progress toward reaching those goals.*

	1 Strongly Disagree
	2 Disagree
	3 Partly Agree, Partly Disagree
	4 Agree
	5 Strongly Agree

Comments (Optional)

17. Counselling helped me to improve the quality of my life.*

	1 Strongly Disagree
	2 Disagree
	3 Partly Agree, Partly Disagree
	4 Agree
	5 Strongly Agree

Comments (Optional)

18. Overall, therapy was very helpful.*

	1 Strongly Disagree
	2 Disagree
	3 Partly Agree, Partly Disagree
	4 Agree
	5 Strongly Agree

Comments (Optional)

19. I would come back to see the therapist again if the need arose.*

	Yes, For Sure
	Not Sure
	No

Comments (Optional)

20. I would recommend the services of Cobb & Associates Inc. without reservation.*

	Yes, For Sure
	Not Sure
	No

Comments (Optional)

21. Please check one of the statements below that best matches your primary reason for ending counselling. *

	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:

22. (OPTIONAL): This last part is optional, but very helpful to us, particularly in explaining your ratings. If your ratings above were high, please tell us one thing that you found to be most helpful about the services you received. If any of the ratings you gave above indicate less than complete satisfaction, we are interested to know what led to the low rating, or what would have made a higher rating possible. Just a sentence or two is sufficient.

If you prefer not to add anything further, that's okay. Just complete the captcha field below, hit the submit button, and you're done. Thank-you for your participation!