Dear Client or Parent:

Please help us by completing this survey in order to evaluate our effectiveness and improve our clinical skills. Your feedback is extremely valuable to us so we can learn and grow. Please do not sign your name. We want you to be completely honest. This does not go directly to providers or staff, but may be used to improve treatment provision and business procedures. If you’d like a response, please email drhilber@hilberpsychsandiego.com directly.

The Therapist's Name

Date

YYYY

1. Did/Do you find therapy to be helpful?

2. What was/is most helpful? Or not helpful?

3. Rate the quality of the treatment (How well it worked/works or how you feel about it)

4. Rate the therapist's empathy, understanding, and listening skills.

5. Rate the therapist's ability to provide a space for you or your child to feel safe.

6. Rate the therapists' level of expertise for your presenting issue.

7. Feedback about the Therapist or Treatment

8. Rate the Intake Process

The Intake Process includes but is not limited to the first contact, intake paperwork, insurance information and confirmation of your appointment.

9. Feedback or other information about HPS, Staff, or your experience

Please note individual names with your comments, concerns, both negative and positive.

Your name and email if a response is preferred (optional)

Hilber psychological services 2022

T: (619) 630-7793
E: info@hilberpsychsandiego.com
F: (619) 923-2773

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