Psychological Service
Client Satisfaction Survey
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We rely upon your opinion to develop and maintain quality psychological service.
Your feedback via this survey will assist Anton Counseling & Health Psychology
to further improve services for you and all our valued clients.

Please use the following scale for each of the following questions.  Please select the number of your choice
for each question to indicate the degree to which you agree with the following statements.

Degree of Agreement:
1 = Strongly Disagree         2 = Disagree        3 = Neutral        4 = Agree        5 = Strongly Agree
                                                                              
                                                                                                                  
                                                                                                                        1           2          3           4          5
1. My coach/psychologist treats me with courtesy and respect.
2. I find my coach/psychologist easy to talk to.
3. My coach/psychologist understands my challenges.
4. My coach/psychologist is knowledgeable, competent and dependable.
5. My psychologist and I work together to develop treatment goals.
6. Coaching helps me manage challenging situations more successfully.
7. My coach/psychologist recommends that I read and/or implement
discussed strategies between sessions.
8. I look at my situations from different points of view and feel that
my attitudes and beliefs expand as a result of my coaching.
9. I am better informed and have a better understanding of factors
that contribute to my challenges and successes.
10. I am treated with courtesy and respect by the receptionist.
11. I feel better, more confident and in control as a result of my coaching
experience.
12. My coach/psychologist helps me to feel comfortable.
13. I consult with my coach/psychologist quarterly or annually.
14. I have referred or recommended my coach/psychologist to others.
15. Please comment on the one thing that sticks in your mind most
     about your psychological coaching experience.
Name
optional