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Client Feedback Form

This document is a client feedback form for a therapist. It asks the client questions about their working relationship with the therapist and the outcomes of their sessions. The client is asked to rate how much they agree with statements about the therapist listening effectively, understanding their point of view, focusing on important issues, and fostering a safe environment. It also asks the client to indicate if they learned strategies, skills, healthier habits, and gained self-confidence or understanding from their sessions. Finally, it asks the client their overall satisfaction level with the therapist and services provided.

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spurthi_16
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868 views

Client Feedback Form

This document is a client feedback form for a therapist. It asks the client questions about their working relationship with the therapist and the outcomes of their sessions. The client is asked to rate how much they agree with statements about the therapist listening effectively, understanding their point of view, focusing on important issues, and fostering a safe environment. It also asks the client to indicate if they learned strategies, skills, healthier habits, and gained self-confidence or understanding from their sessions. Finally, it asks the client their overall satisfaction level with the therapist and services provided.

Uploaded by

spurthi_16
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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CLIENT FEEDBACK FORM

NAME:
This form allows you an opportunity to provide feedback to your therapist after your sessions have finished. This will help your
therapist’s professional development as well as helping to improve the service offered to others
About the working relationship with your therapist

Strongly Somewhat No Somewhat Strongly


agree agree strong disagree disagree
feeling

My therapist listened to me effectively

My therapist understood things from my point of you

My therapist focused on what was important to me

My therapist showed warmth towards me

My therapist fostered a safe and trusting environment

My therapist followed my lead during our sessions whenever that


was appropriate
My therapist provided lead during our sessions when/if that was
appropriate
My therapist challenged me when/if that was appropriate

Statements Yes No

I have learned one or more strategies to solve or cope with problems

I learned to think more clearly and accurately to reduce distressing, emotions or behaviors

I strengthened one or more self-management skills

I live a healthier lifestyle in at least one area. (Example: I get more sleep, exercise, more, eat better,
useless alcohol or other drugs.
I improved my relationship with another person

I increased my ability to recognize, name, and or appropriately express my emotions

I increased my self-confidence or self-esteem

I increased my understanding and appreciation of human differences

What I have learned from my therapist has led to positive changes in my life

Overall Satisfaction

Very Somewhat No strong Somewhat Strongly


satisfied satisfied feeling dissatisfied dissatisfied

My overall level of satisfaction with the


service provided by my therapist is

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