Art Therapy Client Discharge Feedback Form
Please complete this form to share your feedback and experiences as you conclude your art therapy sessions.
Client Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Contact Email
example@example.com
Date of Final Art Therapy Session
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Therapist Name
*
First Name
Last Name
How would you rate your overall experience with art therapy?
*
1
2
3
4
5
Please indicate your level of agreement with the following statements about your art therapy experience.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I felt comfortable expressing myself during sessions
1
2
3
4
5
Art therapy helped me understand my emotions better
6
7
8
9
10
I developed new coping skills through art therapy
11
12
13
14
15
I felt supported by my therapist
16
17
18
19
20
I would recommend art therapy to others
21
22
23
24
25
What art therapy methods or activities did you find most helpful? (Select all that apply)
Drawing/Painting
Sculpture/Clay
Collage/Mixed Media
Digital Art
Group Activities
Other
What changes or improvements have you noticed in yourself since starting art therapy?
*
Please share any suggestions or additional comments about your art therapy experience.
Signature (Please sign below to confirm your feedback and consent)
*
Submit Feedback
Submit Feedback
Should be Empty: