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Home
About
Meet Dr. Perry
Company Info
Services
Therapy
Christian Psychology
Single Session Therapy
Speaking
Concierge
MEDIA
Podcast
FAQ
RESOURCES
Shop
Contact
TREATMENT PROGRESS SURVEY
PATIENT IDENTIFIER #
*
Please do not put your name. Use the unique identifier that was put in your email.
When you first started treatment, how much progress did you expect to make towards your treatment goals?
*
0. No Improvement
1. Some Improvement
2. Moderate Improvement
3. Much Improvement
4. Issue Resolved
Think about the concerns/issues you had when you first started treatment. How much improvement do you think you have actually made towards your treatment goals?
*
0. No Improvement
1. Some Improvement
2. Moderate Improvement
3. Much Improvement
4. Issue Resolved
What barriers have impacted your treatment progress? Select all that apply.
*
Inconsistent attendance
Motivation
Physical Illness
Communication differences with therapist
Therapist approach and style
Lack of support
Distractions in your environment
Finances
Other
None
If other, please specify.
How much do you work on your problems outside of therapy?
*
0. Not at all.
1. Rarely
2. Sometimes
3. Very Often
4. Always
I can openly express my thoughts in sessions.
*
1. Strongly Disagree
2. Disagree
3. Neutral
4. Agree
5. Strongly Agree
I feel respected, understood, and supported by my therapist even when I am challenged.
*
1. Strongly Disagree
2. Disagree
3. Neutral
4. Agree
5. Strongly Agree
My therapist is a good match for me.
1. Strongly Disagree
2. Disagree
3. Neutral
4. Agree
5. Strongly Agree
I am learning new insights about my problems.
*
1. Strongly Disagree
2. Disagree
3. Neutral
4. Agree
5. Strongly Agree
I am learning new ways to deal with my problems.
*
1. Strongly Disagree
2. Disagree
3. Neutral
4. Agree
5. Strongly Agree
My therapist and I are working on what's important to me.
*
1. Strongly Disagree
2. Disagree
3. Neutral
4. Agree
5. Strongly Agree
Please indicate any areas of positive change since you started treatment. Select all that apply.
*
Self-care
Sleep
Romantic relationships
Family relationships
Work/Social relationships
Stress level
Spirituality
Self-esteem
Career
I would recommend my therapist to others.
1. Strongly Disagree
2. Disagree
3. Neutral
4. Agree
5. Strongly Agree
Comments/Feedback
Please share any comments/feedback about your treatment and/or therapist.
Thank you for completing the survey! Dr. Perry will review your answers and discuss them with you.