Client Feedback Form

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As a professional therapist I am required to audit efficacy by collecting client feedback. I would be very grateful if you could complete the following very short questionnaire....there are only 5 questions, I promise!
The form does not ask for any personal details (apart from your initials), my website is secure and of course your answers are completely confidential.

Many thanks
Tracy

What are your initials?

Your Initals

What was the reason you came for hypnotherapy?

I know some of you may identify with more than one category so please go ahead and choose the one most relevant for you.

Addiction

Anxiety and/or Stress

Confidence and/or Self Esteem

Depression

Emotional Trauma

Habit Disorder

Health Concerns

Insomnia

Job or Student Skills

Phobia

Quit Smoking

Weight Management

Well Being

Other Issues

How many sessions did we have together?

One

Two

Three

Four or more

How would you rate your improvement regarding your [f2] on a scale of 1 to 10, where 1 is 'No Improvement' and 10 is 'Much Improved'

I would find it very helpful if you would share your thoughts with me about your therapy and our sessions together. Any comments, suggestions and reviews for Hypnotherapy for Health positively help me to improve my service by knowing what is good (hopefully!) and what needs to be better.

Please indicate below if you agree for your views to be used anonymously for marketing purposes. You can withdraw consent at any time by contacting me and your details are never passed to any third parties.

Agree

Disagree

Thank you for taking the time to submit your feedback.
I do hope that you found hypnotherapy to be a beneficial experience and if I can be of any further assistance in achieving your goals, please feel free to call or email me anytime.
If you need your recordings resent digitally or feel like another might be useful for you to continue your therapy at home, just let me know and I'll send you the download link.