THERAPY OUTCOMES QUESTIONNAIRE
First Name
Last Name
E-mail Address
Please use the drop down menus to rate your therapy experience at Best Life Counseling
I was given choices about my treatment
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Please put the number by the response under each statement that you feel most closely matches your experience:
Choice 1=Highly Agree
Choice 2=Mostly Agree
Choice 3=Slightly Agree
Choice 4=Neutral
Choice 5=Slightly Disagree
Choice 6=Mostly Disagree
Choice 7=Highly Disagree
The Therapist Explained the Risks / Benefits of Therapy
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1 Highly agree
2 Mostly agree
3 Slightly Agree
4 Neutral
5 Slightly Disagree
6 Mostly Disagree
7 Highly Disagree
I was treated with respect by the therapist
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1=Strongly Agree
2=Mostly Agree
3=Slightly Agree
4=Neutral
5=Slightly Disagree
6=Mostly Disagree
7=Highly Disagree
The Treatment plan was explained to me
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1=Strongly Agree
2=Mostly Agree
3=Slightly Agree
4=Neutral
5=Slightly Disagree
6=Mostly Disagree
7=Strongly Disagree
I was satisfied with the counseling I received
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1=Strongly Agree
2=Mostly Agree
3=Slightly Agree
4=Neutral
5=Slightly Disagree
6=Mostly Agree
7=Strongly Disagree
I would return to the therapist (if needed)
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1=Strongly Agree
2=Mostly Agree
3=Slightly Agree
4=Neutral
5=Slightly Disagree
6=Mostly Disagree
7=Strongly Disagree
