Therapist Evaluation Survey Please enable JavaScript in your browser to complete this form.Who is your Therapist?My therapist cares about me and wants to see me make healthy changes.Yes/Always/AgreeSometimesNo/Never/DisagreeMy therapist demonstrates good boundaries by being professional, yet relatable and does not overshare about his/her personal life.Yes/Always/AgreeSometimesNo/Never/DisagreeMy therapist does not touch me inappropriately and only initiates touch as a supportive gesture (handshake, pat on back, friendly hug) upon my consent.Yes/Always/AgreeSometimesNo/Never/DisagreeMy therapist is qualified to address my specific concerns.Yes/Always/AgreeSometimesNo/Never/DisagreeMy therapist is consistently available and does not frequently cancel or reschedule my sessionsYes/Always/AgreeSometimesNo/Never/DisagreeMy therapist maintains my confidentiality.Yes/Always/AgreeSometimesNo/Never/DisagreeMy therapist has helped me reach personal goals.Yes/Always/AgreeSometimesNo/Never/DisagreeMy therapist has demonstrated positive regard for me and has not judged me.Yes/Always/AgreeSometimesNo/Never/DisagreeMy therapist creates a comfortable environment where I feel safe and valued.Yes/Always/AgreeSometimesNo/Never/DisagreeMy therapist is not distracted by calls, texts, etc. during our sessions.Yes/Always/AgreeSometimesNo/Never/DisagreeMy therapist does not simply order me to do things, or readily give advice, but rather helps me explore options, pros/cons, etc. Yes/Always/AgreeSometimesNo/Never/DisagreeI feel I can discuss with my therapist any issues that I am uncomfortable with or unsure of regarding the therapeutic process or counseling relationship.Yes/Always/AgreeSometimesNo/Never/DisagreePlease rate your therapist on a scale of 1-10, 1 being poor, 5 being average, and 10 being excellent Selected Value: 0 CommentsThank you for your time. We appreciate your feedback! Terms of Use *Yes, I want to submit this formBy submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.EmailSubmit
