Clients - Client Feedback Form

Client Feedback Form

Choose your nearest DFS clinic *

Today's Date *

Administration *

Strongly AgreeAgreeUndecidedDisagreeStrongly Disagree

1. My appointment was scheduled in a timely manner

Strongly AgreeAgreeUndecidedDisagreeStrongly Disagree

2. I was offered a variety of times for my appointment

Strongly AgreeAgreeUndecidedDisagreeStrongly Disagree

3. I found the administration and support staff helpful

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4. My Service Provider made sure I understood my rights as a client

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Clinical / Therapy Experience / Practitioner *

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5. My Service Provider showed understanding of my presenting issues

Strongly AgreeAgreeUndecidedDisagreeStrongly Disagree

6. My Service Provider and I identified goals for me to make progress from my sessions.

Strongly AgreeAgreeUndecidedDisagreeStrongly Disagree

7. My Service Provider helped me to understand my self/issues/situation more clearly

Strongly AgreeAgreeUndecidedDisagreeStrongly Disagree

8. I found the services offered by Direct Focus Solutions to be helpful to myself and/or my family

Strongly AgreeAgreeUndecidedDisagreeStrongly Disagree

9. I found the services offered by Direct Focus Solutions to be respectful and free of discrimination

Strongly AgreeAgreeUndecidedDisagreeStrongly Disagree

10. I would recommend Direct Focus Solutions to others

Strongly AgreeAgreeUndecidedDisagreeStrongly Disagree

11. I would use Direct Focus Solutions again*

Strongly AgreeAgreeUndecidedDisagreeStrongly Disagree

* If Undecided / Disagree / Strongly Disagree please comment below.

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