At Restore, we’re committed to continually enhancing our services. Please take a moment to share your experience with us and let us know how we could better serve you in the future. Name First Name Last Name Email Phone (###) ### #### Therapy Provider: Sarah Allen Leslie Smith Melody Pantuso Courtney Caywood Survey My therapist helped me achieve my mental health goals Strongly Disagree Disagree Neutral Agree Strongly Agree My therapist helped me obtain coping skills for future problems Strongly Disagree Disagree Neutral Agree Strongly Agree My therapist showed interest in my needs Strongly Disagree Disagree Neutral Agree Strongly Agree My therapist involved me in treatment planning Strongly Disagree Disagree Neutral Agree Strongly Agree My therapist was professional and attentive Strongly Disagree Disagree Neutral Agree Strongly Agree My therapist was prepared for sessions and knowledgable Strongly Disagree Disagree Neutral Agree Strongly Agree Do you have any specific concerns or complaints about your treatment? What were some things that were especially good about your treatment? Are there any issues or concerns you would like to have addressed? I would like to receive a text or phone call to schedule with a different therapist at Restore Counseling Center. Yes, Please! No, thank you Thank you for your feedback.
