Psychotherapy and Life Coaching

for  Children, Teens, and Women

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Quality Improvement Questionnaire

Please help me to improve the quality of the services I provide by answering a few questions.  You do not submit your name with this form, so please feel free to be completely honest.  I appreciate your help.

 Please check the appropriate box:

 1.  How satisfied are you with the quality of services you (or your child) received?

2.  How helpful have I been to you (or your child)?

3.  Please rate how well you (or your child) felt listened to and understood.

4.  How well have I communicated with you (or your child)?


5.  Please rate the amount of take-home information/exercises you (or your child) received.


Please feel free to make specific comments or suggestions below.



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