ROBYN E. BRICKEL, M.A., LMFT, LLC
Therapy Feedback Form
Your comments and suggestions are appreciated and will help make services more effective for future clients. Any information obtained is both anonymous and confidential.
Please select your therapist
Robyn E. Brickel
Robin M. Gilmore
Are you willing to have your comments used anonymously for promotional materials?
Rate Issue Severity and Your Therapist
Please rate the following on a scale of 1 (low) to 5 (high):
Severity of Original Issue at First Meeting
Current Severity of Original Issue
Overall Effectiveness of Therapy
Professionalism of Therapist
Understanding of Therapist
Overall Effectiveneess of Therapist
What part of therapy was MOST helpful for you?
What part of therapy was the least helpful for you?
As a result of this experience, what strategies or knowledge will you use?
Reason for terminating services:
Optional: Contact Details
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