Client Satisfaction Survey

Thank you for taking the time to complete this brief survey about your experience at Houston Relationship Therapy-Dr. Viviana Coles & Associates. As a learning institution, this feedback is very valuable.

Name*
First Last
We will only used the information you provide for training purposes. Please indicate if you would prefer to remain "anonymous".
Date
Date Format: MM slash DD slash YYYY
Your Therapist's Name:*
How many sessions did you attend (estimate)?*
Which option BEST describes your experience at HRT?*
Please note that this is about the QUALITY of the services you received by your therapist, regardless of the outcome of your therapy sessions.
Please tell us why you chose the option above:*
Would you recommend HRT to others?*
Your Testimonial (optional but greatly appreciated):
Much like you, most potential clients appreciate hearing about others' experiences at HRT. Please share a brief (or long) testimonial about your experience and we may share it on our website without your full names attached. Thanks in advance.
Permission to publish your Testimonial:*
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Email
This field is for validation purposes and should be left unchanged.