Feedback Survey

Thank you for using Life Solutions services. Your feedback is valuable to help us improve! Our goal is to ensure clients have a provider who is the best fit for them and we want to make sure you have a positive experience overall. Below are a few questions to give us an idea of any improvements or feedback you may have after your first visit.

*Questions are adapted from Scott Miller’s Session Rating Scale.

Your Full Name:

Your Therapist’s Name: *

Please rate your appointment/services with your clinician so far.

Selected Value: 1

1: I did not feel heard, understood, and respected

10: I felt heard, understood, and respected

Additional Comments:

Goals and Topics in your sessions

Selected Value: 1

1: We did not work on or talk about
what I wanted to work on and talk about

10: We worked on or talked about
what I wanted to work on and talk about

Additional Comments:

Your therapist’s approach or method

Selected Value: 1

1: The therapist’s approach
was not a good fit for me

10: The therapist’s approach
was a good fit for me

Additional Comments:

Your Overall Rating of the Appointment

Selected Value: 1

1: Overall there was something missing in the session

10: Overall our session was right for me

Additional Comments:

How was your experience with scheduling and appointment at Life Solutions?

Selected Value: 1

1: It was difficult to get in touch with
and Schedule an appointment

10: It was easy to get in touch with
and Schedule an appointment

If below a 10, please let us know how we can improve:

Do you have any feedback for us to make your experience or the experience of future clients better?

By submitting this form via this web portal, you acknowledge and accept that 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. *

Yes, I want to submit this form

We sincerely appreciate your feedback, take every response seriously, and use the information to improve clients’ experience at Life Solutions: Integrative Healing.

Thank you again!

Feedback Survey

Got Questions?Send a Message!

Got Questions?
Send a Message!