Child Therapy Termination Activity Feedback Questionnaire
Please provide your feedback on the recent therapy termination activity to help us improve our services and better support children in future sessions.
Child's Full Name
*
First Name
Last Name
Date of Termination Activity
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name of Therapist
*
Termination Activity Name
*
How would you rate the overall experience of the termination activity?
*
1
2
3
4
5
Please indicate your agreement with the following statements about the termination activity.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The child understood the purpose of the activity
1
2
3
4
5
The activity helped the child express their feelings
6
7
8
9
10
The activity provided closure for the therapy process
11
12
13
14
15
The child felt comfortable during the activity
16
17
18
19
20
The activity was age-appropriate
21
22
23
24
25
What aspects of the termination activity were most helpful for the child?
Were there any challenges or difficulties observed during the activity?
What changes or improvements would you suggest for future termination activities?
Did the child demonstrate new skills or coping strategies as a result of therapy?
*
Yes
No
Not Sure
Please describe any notable changes in the child's behavior or emotional state following the termination activity.
Would you recommend this type of termination activity for other children completing therapy?
*
Yes
No
Maybe
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