Client Care Follow-up Survey Client Care Follow-up SurveyThank you for taking the time to share your thoughts with us. This survey is designed to help us understand your experience with therapy and the support you receive. Your honest feedback is incredibly valuable in helping us improve our services, recognize the hard work of our counselors, and ensure that we are meeting your needs. Your responses will remain confidential, and your feedback will be used to improve therapy services and to provide a better experience for all clients. The survey should take about 5-10 minutes to complete. If at any point you feel uncomfortable or prefer not to answer a question, feel free to skip it.1.a Survey Date: MM slash DD slash YYYY 1.b Person filling out this survey: Individual receiving services Parent or legal guardian of individual receiving services 2.a Name of individual receiving services: First Last If under the age of 18, please also list parent or legal guardian's name below.2.b Date of Birth: MM slash DD slash YYYY 3. Guardian's Name: First Last 4.a Generally, how many times do you see your counselor(s) on a weekly basis? 1 time a week 2 times a week 3 times a week 1 time a month 2 times a month I have not seen my counselor this month Other (describe) 4.b Describe other.5.a Approximately how long are your counseling sessions? 15 minutes 30 minutes 45 minutes 1 hour 1 hour and 15 minutes 1 hour and 30 minutes 1 hour and 45 minutes 2 hours Other 5.b Describe other.6.a Where do you typically see your counselor for appointments? Still Waters Office Home School Telehealth (Virtual sessions) Other 6.b Describe other.7. Rate your level of satisfaction with Still Waters COUNSELOR(s). (1) Highly Dissatisfied (2) Dissatisfied (3) Neutral - neither Satisfied or Dissatisfied (4) Satisfied (4) Highly Satisfied 8.a Have you had any challenges or barriers accessing therapy with your counselor? Cancelled appointments by counselor Missed appointments Transportation issues Technical issues with virtual sessions Other Check all that apply.8.b Describe other.9. Rate the overall effectiveness of the counseling services you receive(d) from Still Waters. (1) Highly ineffective (2) Ineffective (3) Neutral - neither effective or ineffective (4) Effective (4) Highly effective 10. Do you feel that you (or the individual you represent) has benefited from receiving counseling from Still Waters? Yes No Unsure 11. Would you like to continue to see your current counselor or request a new counselor? Continue with current counselor Request a new counselor 12. Free response - COUNSELOR SPOTLIGHT! Has your counselor gone above and beyond? Please share how they've made a positive impact - we'd love to recognize their great work!13. Free response - Any comments or suggestions concerning your experience with Still Waters Counseling? Is there anything you’d like us to improve? Δ