Aspire Neuropsychological Services | Therapy & Therapist Feedback Form

We are glad that you reached out to Aspire Neuropsychological Services, Inc. Our goal is to ensure that our clients are matched with a clinician who is the best fit for them and we want you have a positive experience overall. Below are a few questions designed to provide your feedback and to help us make any improvements. If you have the time, we would love to hear from you!

– Any feedback regarding clinicians will be reported anonymously unless otherwise requested.
– Questions are adapted from Scott Miller’s Session Rating Scale.

survey

Name*
Email Address*
This helps us provide feedback and support to Aspire's clinicians.
Your Clinician's Name*
Please rate your sessions with your clinician
I feel heard, understood, and respected*
On a scale of 1-10, with 10 being the best
1 2 3 4 5 6 7 8 9 10
Additional Comments
We worked on and talked about what I hoped
On a scale of 1-10, with 10 being the best
1 2 3 4 5 6 7 8 9 10
Additional Comments
Therapist's approach was a good fit for me
On a scale of 1-10, with 10 being the best
1 2 3 4 5 6 7 8 9 10
Additional Comments
Overall our session was right for me
On a scale of 1-10, with 10 being the best
1 2 3 4 5 6 7 8 9 10
Additional Comments
How are you feeling? Use a scale of 1-10, with 10 being the best.
How well have been doing in the following areas of your life? Please use a scale of 1-10, with 10 being the best. If you are filling out this form for another person, please fill out according to how you think they are doing.
Individually (personal well-being)
Scale of 1-10, with 10 being the best
1 2 3 4 5 6 7 8 9 10
Additional Comments
Interpersonally (family, close relationships)
Scale of 1-10, with 10 being the best
1 2 3 4 5 6 7 8 9 10
Additional Comments
Socially (work, school, friendships)
Scale of 1-10, with 10 being the best
1 2 3 4 5 6 7 8 9 10
Additional Comments
Overall (general sense of well-being)
Scale of 1-10, with 10 being the best
1 2 3 4 5 6 7 8 9 10
Additional Comments
How likely is it that you would recommend Aspire Neuropsychological Services, Inc. to a friend or colleague?
Very Likely Likely Not Likely
Additional Comments
Your experience with administrative staff
Please let us know your experience with scheduling and billing.
Was it easy to schedule an appointment?
Very easy Easy Average Not easy Difficult
If it was difficult or not easy to schedule an appointment, please let us know how we can improve.
Did you have a good experience with billing?
Very good Good Average Not good Bad
If you did not have a good experience with billing, 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?
Thank You
We sincerely appreciate your feedback and take every response seriously and use the information to improve clients' experience at Aspire Neuropsychological Services, Inc.
Thank you again!

Give us your feedback

survey

This helps us provide feedback and support to Aspire's clinicians.

Please rate your sessions with your clinician

How are you feeling? Use a scale of 1-10, with 10 being the best.

Your experience with administrative staff

Thank You

Services

Meet Our Clinicians

New Clients

Contact Us

Map To Our Office

Join Our Email List
for Inspirational Quotes!

Give us your feedback

survey

This helps us provide feedback and support to Aspire's clinicians.

Please rate your sessions with your clinician

How are you feeling? Use a scale of 1-10, with 10 being the best.

Your experience with administrative staff

Thank You

Services

Meet Our Clinicians

New Clients

Contact Us

Map To Our Office

Join Our Email List for Inspirational Quotes!

Join Our Email List
for Inspirational Quotes!