Name * First Name Last Name Email Which services have you used at Cognitive Consultants? * Check all that apply) CBT Trauma Informed CBT EMDR Group Therapy Family Therapy Couples Therapy Anxiety, Depression or Grief Counseling Medication Assisted Treatment (MAT) Moral Reconation Therapy Other: Survey These services have been helpful in your mental health or recovery journey: Strongly Disagree Disagree Neutral Agree Strongly Agree What barriers, if any, have prevented you or your family from seeking therapy? (Check all that apply) Cost Insurance Shame or stigma Transportation Childcare Scheduling conflicts Negative experiences with therapy Other: How do you prefer to do therapy? In-Person Virtually No preference Are there any topics, services or support groups you would like us to offer? Office Experience Our staff made you feel welcome and gave you clear information upon arriving for your appointment Strongly Disagree Disagree Neutral Agree Strongly Agree Our clinical staff made you feel comfortable and supported during your sessions Strongly Disagree Disagree Neutral Agree Strongly Agree Demographic information Gender Woman Man Non-Binary Two-Spirit Prefer Not to Say Other Age Group Under 18 18-24 25-34 35-54 55-64 64 and over Prefer not to say Thank you for taking the time to fill out this survey! Your feedback is valuable to us.
