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Post Therapy Outcomes Questionnaire (for Therapists)

Client First Name:
Client Last Name:
Email
Today’s date:
MM slash DD slash YYYY
Date of first therapy appointment
MM slash DD slash YYYY
Date of final therapy appointment
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:

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Thank you for submitting an application to the Pro Bono Counseling Project. We will review your application and get back to you in the next 72 hours. Our goal is to match you with a therapist who can meet your needs as soon as possible. In the meantime, check out our website to learn more about the project.