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 rate your most recent session by using 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. I feel heard, understood, and respected.
2. We work on and talk about what I want to work on and talk about.
3. My Psychologist’s approach is a good fit for me.
4. Overall, my sessions are right for me.
5. I consult with my coach/psychologist quarterly or annually.
6. I have referred or recommended my coach/psychologist to others.
7. Please comment on the one thing that sticks in your mind most
     about your psychological coaching experience.
Name
optional