Therapeutic Outcomes Evaluation Questionnaire Form
Therapeutic Outcomes Evaluation Questionnaire Form – Please complete this form to help us evaluate your therapy outcomes. Your feedback supports ongoing improvement.
Overall, how satisfied are you with your therapy experience?
*
Not satisfied
1
2
3
4
5
6
Extremely satisfied
7
1 is Not satisfied, 7 is Extremely satisfied
To what extent have your therapy goals been met so far?
*
Not at all
1
2
3
4
5
6
Completely
7
1 is Not at all, 7 is Completely
Please rate your progress in managing symptoms since starting therapy.
*
No progress
1
2
3
4
5
6
Significant progress
7
1 is No progress, 7 is Significant progress
How comfortable do you feel communicating with your therapist?
*
Not comfortable
1
2
3
4
5
6
Very comfortable
7
1 is Not comfortable, 7 is Very comfortable
How likely are you to recommend this therapy to others?
*
Not likely
1
2
3
4
5
6
Extremely likely
7
1 is Not likely, 7 is Extremely likely
Which areas have you experienced the most improvement in?
Mood
Anxiety
Relationships
Coping skills
Self-esteem
Other
Please indicate your level of agreement with the following statements.
*
Rows
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
I feel more in control of my emotions.
1
2
3
4
5
I use coping strategies learned in therapy.
6
7
8
9
10
I feel supported by my therapist.
11
12
13
14
15
Therapy sessions are structured and effective.
16
17
18
19
20
What has been the most helpful aspect of therapy for you?
What could be improved in your therapy experience?
Any additional comments or feedback?
Submit Evaluation
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