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Post Therapy Outcomes Questionnaire (Client)

Client First Name:
(or Prefer to remain anonymous)
Client Last Name:
(or Prefer to remain anonymous)
Today’s date:
Date Format: MM slash DD slash YYYY
Email
Name of therapist:
I made progress toward my goals.
- Strongly agree (5)
- Agree (4)
- Neutral (3)
- Disagree (2)
- Strongly disagree (1)
I am satisfied with the progress I made.
- Strongly agree (5)
- Agree (4)
- Neutral (3)
- Disagree (2)
- Strongly disagree (1)
I can talk to friends or family members about my mental health.
- Strongly agree (5)
- Agree (4)
- Neutral (3)
- Disagree (2)
- Strongly disagree (1)
My mental health improved because of therapy.
- Strongly agree (5)
- Agree (4)
- Neutral (3)
- Disagree (2)
- Strongly disagree (1)
My mental health improved because of other reasons.
- Strongly agree (5)
- Agree (4)
- Neutral (3)
- Disagree (2)
- Strongly disagree (1)
My work situation improved (new job, better job, better hours, better pay or benefits, better attendance)
- Strongly agree (5)
- Agree (4)
- Neutral (3)
- Disagree (2)
- Strongly disagree (1)
My education improved (went back to school, stayed in school, better attendance)
- Strongly agree (5)
- Agree (4)
- Neutral (3)
- Disagree (2)
- Strongly disagree (1)
My overall well-being improved (general sense of well-being, life satisfaction).
- Strongly agree (5)
- Agree (4)
- Neutral (3)
- Disagree (2)
- Strongly disagree (1)
My close relationships improved (better communication, less conflict).
- Strongly agree (5)
- Agree (4)
- Neutral (3)
- Disagree (2)
- Strongly disagree (1)
Other relationships improved (work, school, friends)
- Strongly agree (5)
- Agree (4)
- Neutral (3)
- Disagree (2)
- Strongly disagree (1)
My finances improved (more stable, better decision making).
- Strongly agree (5)
- Agree (4)
- Neutral (3)
- Disagree (2)
- Strongly disagree (1)
My therapist respected my culture, spiritual beliefs, and/ or sexuality.
- Strongly agree (5)
- Agree (4)
- Neutral (3)
- Disagree (2)
- Strongly disagree (1)
I was matched with a clinician who met my needs.
- Strongly agree (5)
- Agree (4)
- Neutral (3)
- Disagree (2)
- Strongly disagree (1)
I would recommend this service to a friend/ family.
- Strongly agree (5)
- Agree (4)
- Neutral (3)
- Disagree (2)
- Strongly disagree (1)
How many sessions did you complete (to the best of your memory)?
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
- more than 12
How many days in the past month would you say your mental health was not good (difficulty coping)?
Reason therapy ended (check all that apply):
- Met my goals
- Finished allotted number of sessions
- Bad fit with therapist
- Unable to continue therapy due to life circumstances (transportation, scheduling, other)
- Obtained insurance (new benefit)
- Sought services elsewhere
- Other:
We welcome any other comments or feedback about your experience: