CLINICAL COUNSELING SERVICES

Satisfaction Survey Form

C405 - Taubman Student Services Center
248-204-4100

Your feed back on the counseling process is appreciated.  Your feedback is voluntary and anonymous.  Results are used to improve our services.  Please choose only one box for each item.  Thank you for your time.

If you would like to discuss your evaluation form with anyone from Clinical Counseling Services, please include your name and a phone number where you may be reached.

*  Providing your name and phone number is optional

First Name
Last Name
Phone Number
(e.g. 123-345-6789)

1.

Todays Date: (MM/DD/YYYY)

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2.

How many sessions have you attended?

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3.

The availability of appointment times.

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Poor
Fair
Good
Very Good
Excellent

4.

The comfort/atmosphere of the office.

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Poor
Fair
Good
Very Good
Excellent

5.

The competence/knowledge of the therapist.

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Poor
Fair
Good
Very Good
Excellent

6.

The quality of care and services.

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Poor
Fair
Good
Very Good
Excellent

7.

The counselor seemed knowledgable about my concerns.

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Poor
Fair
Good
Very Good
Excellent

8.

My counselor helped me understand my thoughts and feelings.

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Poor
Fair
Good
Very Good
Excellent

9.

My Counselor helped me deal more effectively with my problems.

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Poor
Fair
Good
Very Good
Excellent

10.

I would return to Clinical Counseling Services if i needed help in the future.

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Poor
Fair
Good
Very Good
Excellent

11.

I would recommend clinical counseling services to a friend.

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Poor
Fair
Good
Very Good
Excellent

12.

Counseling helped me improve my academic performance.

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Poor
Fair
Good
Very Good
Excellent

13.

I felt my counselor was genuinely interested in helping me.

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Poor
Fair
Good
Very Good
Excellent

14.

Overall, I am satisfied with my counseling experience.

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Poor
Fair
Good
Very Good
Excellent

15.

Comments: