Client Feedback Form

Our mission at Juniper Therapeutic Services is to provide that best trauma-informed care we can to our clients. Your feedback is incredibly important in achieving this goal. We are grateful for your time and care in filling out this form.

Name

First Name

Last Name

Date

YYYY

If you have not returned to counseling, please let us know why. (You can choose more than one option)

I have reached my goals and come to a satisfactory end

Financial Reasons

Therapy doesn't fit into my life right now

My therapist was not a good fit for me

Testimonial

Positive reviews and testimonials are crucial to the success of Juniper Therapeutic Services. We would greatly appreciate a testimonial that we may use for our marketing content. For confidentiality purposes, we will only include your first name and last name initial--e.g. Mollie V.