Milestone Counseling Feedback Form

Please do not include any personal or identifying information (names, dates of birth, specific events, or medical details). Your responses may be used in a general way for testimonials or to improve our services.

Which clinician do you see? *

About how long have you been working with a clinician at Milestone Counseling?

What made you choose Milestone Counseling?(You may share what stood out to you, what you were looking for, or what helped you feel we were the right fit.)

Overall, how satisfied are you with your experience at Milestone Counseling?Scale: 1 = Not satisfied, 5 = Very satisfied12345

Since beginning counseling, how much progress do you feel you’ve made toward your goals?Scale: 1 = No progress yet, 5 = Significant progress12345

What changes or progress have you noticed in yourself?(This might include shifts in insight, coping skills, confidence, communication, or daily functioning.)

How supported do you feel by your clinician?Scale: 1 = Not supported, 5 = Very supported12345

How would you describe the environment and overall experience at Milestone?(Consider the atmosphere, communication, accessibility, and how comfortable you feel.)

Is there anything we could improve to better support you?(Your feedback helps us strengthen our services and client experience.)

Testimonial (Optional)If you’re comfortable, please share a brief statement about your experience that we may use in a general way for testimonials. (Please do not include any personal or identifying information: names, dates of birth, specific events, or medical details).

I understand my response may be used as a testimonial without identifying information. *Please make a selectionYes I consentNo I don’t consent

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