Psychotherapy and Life Coaching

for Children, Teens, and Women

Home Psychotherapy Life Coaching QIQ Contact Autobiography

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.