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About Us
- Our Story
- Fees & Insurance
Our Specialities
Our Team
Contact Us
Resources
- Our Blog
- Podcast
Hiring

About Us
- Our Story
- Fees & Insurance
Our Specialities
Our Team
Contact Us
Resources
- Our Blog
- Podcast
Hiring

Santos Counseling PLLC Client Satisfaction Survey

Thank you so much for trusting us.

We promise to value your feedback and use it to better our all-around service. Please let us know about your experience with Santos Counseling PLLC.

Please know that it is optional to leave information.

Counseling In Greensboro North Carolina.

Santos Counseling PLLC Satisfaction Survey

Name *

First

Last

Email *

Please answer the following (1- Strongly disagree, 2- Somewhat disagree, 3- Neutral, 4- Somewhat agree, 5- Strongly agree)

How likely is it that you would recommend Santos Counseling PLLC to a friend or colleague? *

5 - Very likely
4 - Somewhat likely
3 - Neutral
2 - Somewhat unlikely
1 - Very unlikely

Overall, how satisfied or dissatisfied are you with Santos Counseling PLLC? *

5 - Very satisfied
4 - Somewhat satisfied
3 - Neither satisfied nor dissatisfied
2 - Somewhat dissatisfied
1 - Very dissatisfied

Counseling appointments have been made available when I needed them. *

5
4
3
2
1

Which of the following words would you use to describe your experience with Santos Counseling PLLC? Select all that apply. *

Helpful
Reliable
Good value for the money
Exceeded my expectations
Ineffective
Unreliable

Were there services that you needed that weren’t offered?

Counselor Satisfaction

What is the name of your therapist?

I felt safe and comfortable to talk about my issues in counseling. *

5
4
3
2
1

I was treated respectfully by my counselor. *

5
4
3
2
1

I feel confident that my counselor protected my privacy. *

5
4
3
2
1

Do you have any other comments, questions, or concerns?

Therapy In Greensboro, NC.

Contact Us

Name *

First

Last

Best Number To Reach You *

Email *

How would you like to be contacted? *

Text
Call
Email

What type of counseling do you need? *

Counseling for my child
Couples counseling
Family Counseling
Counseling for myself

If you are not certain, please list what you feel would be the most important primary service to start with. The intake coordinator will support you during the scheduling process.

Have you ever been seen by Santos Counseling? *

Yes
No

Please specify the client's age range. *

Do you prefer In-Person or Virtual? *

In-Person
Virtual

Please share what brings you to therapy. *

Anxiety
OCD
Depression
Life Transition
Relationship/Marriage
Parent and Child Difficulties
Trauma
ADD/ADHD
Grief and Loss
School/Educational Challenges
LGBTQIA+
Multicultural Issues
Stress

Please check multiple age boxes if needed. Please only add information you are comfortable sharing. This is not a HIPAA compliant form. The completion of the form does not establish a counselor and client relationship. If you're experiencing a crisis that can't wait, please first contact 911 or go directly to your nearest emergency department.

What insurance plan are you on? *

Anything else you would like for us to know? *

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