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Post Therapy Outcomes Questionnaire (for Therapists)

First Name:
Last Name:
Email
Today’s date:
Date Format: MM slash DD slash YYYY
Date of first therapy appointment
Date Format: MM slash DD slash YYYY
Date of final therapy appointment
Date Format: MM slash DD slash YYYY
Number of sessions provided:
Name of therapist:
The client made progress toward their goals.
- Strongly agree (5)
- Agree (4)
- Neutral (3)
- Disagree (2)
- Strongly disagree (1)
The client was satisfied with the progress made.
- Strongly agree (5)
- Agree (4)
- Neutral (3)
- Disagree (2)
- Strongly disagree (1)
The client was able to talk to friends or family members about their mental health.
- Strongly agree (5)
- Agree (4)
- Neutral (3)
- Disagree (2)
- Strongly disagree (1)
The client’s mental health improved because of therapy.
- Strongly agree (5)
- Agree (4)
- Neutral (3)
- Disagree (2)
- Strongly disagree (1)
The client’s mental health improved because of other reasons.
- Strongly agree (5)
- Agree (4)
- Neutral (3)
- Disagree (2)
- Strongly disagree (1)
The client’s 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)
The client’s education improved (went back to school, stayed in school, better attendance)
- Strongly agree (5)
- Agree (4)
- Neutral (3)
- Disagree (2)
- Strongly disagree (1)
The client’s overall well-being improved (general sense of well-being, life satisfaction).
- Strongly agree (5)
- Agree (4)
- Neutral (3)
- Disagree (2)
- Strongly disagree (1)
The client’s close relationships improved (better communication, less conflict).
- Strongly agree (5)
- Agree (4)
- Neutral (3)
- Disagree (2)
- Strongly disagree (1)
The client’s other relationships improved (work, school, friends)
- Strongly agree (5)
- Agree (4)
- Neutral (3)
- Disagree (2)
- Strongly disagree (1)
The client’s finances improved (more stable, better decision making).
- Strongly agree (5)
- Agree (4)
- Neutral (3)
- Disagree (2)
- Strongly disagree (1)
I was matched with a client who was appropriate to the level of care I could provide in short term counseling.
- Strongly agree (5)
- Agree (4)
- Neutral (3)
- Disagree (2)
- Strongly disagree (1)
I would recommend this project to a colleague, a friend/ family.
- Strongly agree (5)
- Agree (4)
- Neutral (3)
- Disagree (2)
- Strongly disagree (1)
Reason therapy ended (check all that apply):
- Goals Met
- 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: