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  • Psychotherapy Feedback Form

    Transféré par

    Starlin Vijay Mythri
    17 vues2 pages
    Clinical feedback form

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    Clinical feedback form

    Droits d'auteur :

    © All Rights Reserved
    Téléchargez comme DOCX, PDF, TXT ou lisez en ligne sur Scribd
    Signaler comme contenu inapproprié
    17 vues2 pages

    Psychotherapy Feedback Form

    Transféré par

    Starlin Vijay Mythri
    Clinical feedback form

    Droits d'auteur :

    © All Rights Reserved
    Téléchargez comme DOCX, PDF, TXT ou lisez en ligne sur Scribd
    Signaler comme contenu inapproprié
    sur 2

    Please could you take a few minutes to fill out this feedback form.

    Your feedback about our service is valuable to us. Feedback from your experience with us helps us to develop our
    services and improve quality.

    Name: age: sex: date:

    I was kept fully informed regarding any changes with appointments

    Strongly disagree/ Disagree/ Neither agree nor disagree/ Agree/ Strongly agree

    The environment of my appointment session suited my needs

    Strongly disagree/ Disagree/ Neither agree nor disagree/ Agree/ Strongly agree

    I feel my psychologist listened to me

    Strongly disagree/ Disagree/ Neither agree nor disagree/ Agree/ Strongly agree

    I felt understood by my psychologist

    Strongly disagree/ Disagree/ Neither agree nor disagree/ Agree/ Strongly agree

    My psychologist has helped me to reduce my levels of distress

    Strongly disagree/ Disagree/ Neither agree nor disagree/ Agree/ Strongly agree

    I feel that I can trust my psychologist

    Strongly disagree/ Disagree/ Neither agree nor disagree/ Agree/ Strongly agree

    I feel that my functioning on a day to day basis has improved

    Strongly disagree/ Disagree/ Neither agree nor disagree/ Agree/ Strongly agree

    My psychologist has helped me to understand my problems

    Strongly disagree/ Disagree/ Neither agree nor disagree/ Agree/ Strongly agree

    I feel I have learned to cope with my problems

    Strongly disagree/ Disagree/ Neither agree nor disagree/ Agree/ Strongly agree

    I feel that my quality of life has improved


    Strongly disagree/ Disagree/ Neither agree nor disagree/ Agree/ Strongly agree

    I feel that the psychology service has been important to my overall care in this hospital

    Strongly disagree/ Disagree/ Neither agree nor disagree/ Agree/ Strongly agree

    I was able to make changes in my life as a result of seeing a psychologist

    Strongly disagree/ Disagree/ Neither agree nor disagree/ Agree/ Strongly agree

    Overall, how would you rate the psychology service you received?

    Very poor/ Poor/ Average/ Good / Excellent

    Please offer any further comments or suggestions:

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