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Who We Are
Referrals
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How satisfied are you with the level of trust you feel with your therapist?
(Required)
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
How satisfied are you with your therapist’s ability to create a non-judgmental space?
(Required)
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
How satisfied are you with how clearly your therapist explains treatment approaches?
(Required)
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
How satisfied are you with your involvement in setting therapy goals?
(Required)
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
How satisfied are you with how supported you feel between sessions (if applicable)?
(Required)
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
How satisfied are you with your therapist’s preparedness and focus during sessions?
(Required)
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
How satisfied are you with your therapist’s openness to feedback?
(Required)
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
How satisfied are you with the services you have received?
(Required)
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
Additional Questions
How long have you been seeing your Athena Women’s Health Therapist?
(Required)
Less than 1 year
1-3 Years
3-5 Years
5+ Years
What is your main purpose for seeking therapy?
(Required)
Improve mental health
Manage trauma or past experiences
Support during major life transition
Working through a specific life event or challenge
Other
The therapist explained the benefits and risks of therapy
(Required)
Yes
No
I have been treated with respect and dignity by the therapist
(Required)
Yes
No
The therapist listens to the concerns I present
(Required)
Yes
No
I can talk to the therapist about treatment goals
(Required)
Yes
No
Services are performed in a time efficient manner
(Required)
Yes
No
The clinic policies have been clearly explained
(Required)
Yes
No
The services provided have been helpful
(Required)
Yes
No
The services have been directed toward helping problem areas
(Required)
Yes
No
I would return to the therapist for services in the future if needed
(Required)
Yes
No
Please share any additional feedback, comments, or information that may help us improve. (text box below)
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