We are interested in knowing to what degree our services have been helpful to you. Your thoughts and feelings about your experience are important to us. Please be frank and honest. Our therapists are aware of and benefit from this evaluation. You do not have to give your name.

When I first came to counseling:
I wanted very much to come.
I somewhat wanted to come.
Someone urged me to come.
Someone else required me to come.

I received the following services from Fall Creek Counseling Associates: (check all that apply)
Individual counseling
Couples counseling
Counseling for my child
Family counseling
Group counseling
Personality testing
Other testing evaluation

Please rate your experiences on the following measures: Excellent Good Fair Poor

1. Confidence in your therapist's ability.
2. Understanding and concern shown to you.
3. Your therapist's ability to understand what your were communicating.
4. Your therapist's ability to communicate clearly to you.
5. Ease of scheduling appointments.
6. Therapist started appointments on time.
7. Therapist ended appointments on time.
8. Professionalism of your therapist.
9. Promptness and accuracy of billing you or your insurance.
10. Promptness of returning your phone calls.
11. Your perception of your therapist's honesty and ethics.
12. Your satisfaction with your therapist's communication with other
professionals involved in your care.

Please select the responses that best describe your experiences:

I think my therapist:

felt positive about working with me
felt negative about working with me.

I think my therapist:
did not give me enough feedback
gave about the right amount
gave too much.

I think my therapist:
talked too much about themselves
didn't share enough about themselves
shared what was appropriate.

I think my therapist
worked on goals important to me
had his/her own goals.

I think my therapist
got to the heart of things
stayed on the surface.

I think my therapist
was motivating
was discouraging.

Would you recommend your therapist to someone else?
Yes
No, because _________________________________

What could they have done better? ___________________________________________________________________________

Would you recommend Fall Creek to someone else?
Yes
No, because ________________________________________

What could Fall Creek have done better? ______________________________________________________________________

Please give us any other comments you'd like: __________________________________________________________________

________________________________________________________________________________________________________

My name (optional): _____________________________________

Thank you for completing this evaluation.