New Client Feedback Form

New Client Feedback Form

At DK Therapy, your feedback matters!

We value your opinion and we always want to improve our services. We appreciate the opportunity to work with you!

Note: your answers are confidential and will not be shared with your therapist.

Name *

First

Last

Overall, how would you rate your experience of your first session at DK Therapy? *

Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 5

How satisfied are you with our speed of response to your email/call? *

Unsatisfied
Neutral
Satisfied

How satisfied are you with scheduling an initial appointment? *

Unsatisfied
Neutral
Satisfied

If applicable, how satisfied were you with the insurance benefit check experience? *

Unsatisfied
Neutral
Satisfied
Not applicable, I did not use insurance

If applicable, how satisfied were you regarding the client portal experience for filling out initial session paperwork? *

Unsatisfied
Neutral
Satisfied
Not applicable, I did not use the client portal for my paperwork

If applicable, how satisfied were you with the online scheduling experience? *

Unsatisfied
Neutral
Satisfied
Not applicable, I did not schedule my appointment online

My therapist began and ended our session on time * *

My therapist was warm and made me feel at ease and comfortable *

Disagree
Neutral
Agree

My therapist was a good listener *

Disagree
Neutral
Agree

I felt respected and not judged by my therapist *

Disagree
Neutral
Agree

My therapist helped me explore my options and solutions *

Disagree
Neutral
Agree

How likely are you to return for a second appointment? *

Unlikely
Neutral
Likely

How likely are you to recommend your therapist to others? *

Unlikely
Neutral
Likely

How likely are you to recommend DK Therapy to others? *

Unlikely
Neutral
Likely

Additional comments or suggestions

Please let us know if there are any changes we can make that would improve your counseling experience.

Comment

Now offering secure, convenient online counseling/therapy sessions! Learn more

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Cancellation Policy

Please note that we require a 24-hour notice if you decide to cancel your appointment. Call or email to cancel or reschedule at least 24 hours before your scheduled appointment in order to avoid charges. We will do our best to accommodate you and appreciate your cooperation. Thank you.

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