Termination Feedback Form

Your feedback is invaluable in helping us understand your needs and continuously improve our services.

We understand that life can get busy, and sometimes circumstances change. We genuinely appreciate the time you spent with us, and we would love to hear about your experience.

Your insights can make a significant impact on our ability to better support individuals like yourself.

Below are some questions designed to gather your thoughts and feelings about your time with Life Balance.

We assure you that your responses will be kept confidential, and your honest feedback is highly appreciated.

Overall, did your experience with us meet or exceed your expectations for therapy?

YES

Who was your primary therapist?

How would you describe your overall experience with our therapists and your therapy sessions?

Please tell us about any specific aspects of the therapy process that you found particularly helpful or challenging:

We understand that people have different reasons for discontinuing therapy. If you feel comfortable sharing, could you provide any insights into what led to your decision not to schedule further sessions?

If you'd like to share your name with our owner, please include it here. Your therapist will NOT be told your identity.

Please let us know if there are any changes we can make that would have improved your counseling experience.

Your feedback is crucial in guiding us to enhance our services and better meet the needs of our clients. We genuinely appreciate your openness and honesty. Thank you for being a part of Life Balance and we wish you all the best on your journey!