Neuropsychological Assessment Feedback Form
Please provide your feedback regarding your recent neuropsychological assessment session. Your responses help us improve our services.
What is your relationship to the assessment?
*
Self
Parent/Guardian
Spouse/Partner
Other Family Member
Other
Assessment date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How understandable was the feedback provided during the session?
*
Not at all understandable
1
2
3
4
Completely understandable
5
1 is Not at all understandable, 5 is Completely understandable
How helpful did you find the feedback/session?
*
Not helpful
1
2
3
4
Very helpful
5
1 is Not helpful, 5 is Very helpful
Were the instructions and explanations during the session clear?
*
Not clear
1
2
3
4
Very clear
5
1 is Not clear, 5 is Very clear
Were the next steps or recommendations explained to you?
*
Yes, completely
Partially
No
Please rate the following aspects of the session:
*
Rows
Poor
Fair
Good
Very Good
Excellent
Professionalism of the clinician
1
2
3
4
5
Respect for your concerns
6
7
8
9
10
Opportunity to ask questions
11
12
13
14
15
Overall, how satisfied are you with the assessment feedback session?
*
1
2
3
4
5
What suggestions do you have for improving the assessment feedback process?
Any additional comments or feedback?
Would you recommend our assessment services to others?
*
Yes
No
Not sure
Submit Feedback
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