Client Feedback Survey
We take feedback from our clients very seriously and always appreciate knowing more about your experience with our office. Please take a moment to let us know how we are doing. This feedback goes to our Clinical Director and our Director of Operations. If you feel more comfortable contacting them directly instead of completing this survey, please email our Director of Operations, Ann Poortinga, at email@example.com or leave a message at (937) 767-9171 for our Clinical Director, Renee Pinkelman.
Who is/was the provider you worked with?
Tim Callahan, PsyD
Jack Campbell, LICDC
Lia Ferrell, LISW
William Ford, MRC
Joyce Girard, LSW, LICDC
Elizabeth Goodall, LPCC
Mark Greenberg, LISW-S
Megan Harcourt, LISW-S
Stanford Harris, LICDC
John "Jack" Layh, PhD
Marlee Layh, PhD
Melissa Layman-Guadalupe, PhD
Kate LeVesconte, PsyD
Renee Pinkelman, LPCC
Marcie Rogers, PhD
Tracy Sebastian, LISW-S
Justin Simons, LPCC
Judy Skillings, PsyD
Louise Smith, LPCC
I have not seen anyone yet
Was this provider a good match for you?
May we contact you to offer a therapist in our practice or another practice that may better suit your needs?
Do you receive virtual services, in-person services, or a hybrid of both?
Hybrid (both virtual and in-person)
Tell us more about your therapy/counseling experience
Your provider's ability to understand your needs
I felt heard by my provider
Not at all
Usefulness of therapy in meeting your needs and goals
Not really useful
Not at all useful
I was provided with information, therapist support, and strategies for emotional health that matched my needs
Overall, how satisfied are you with the care you received from this provider?
Is there anything specific that you would like to share with us about your experience with this provider?
Tell us more about your overall experience with our office
How would you rate your communication with our office staff?
Overall, how do you feel your experience has been with our office staff?
Overall, do you feel better after coming here?
I feel worse
Would you recommend our services to family/friends?
Is there anything specific that you would like to share with us about your experience with our office or the therapist you saw?
Would you like someone from our office to contact you about your experience?
Not at this time
What phone number should we call to contact you about your experience?
Should be Empty: