Community Feedback Form - Counseling Connections for Change, Inc

Let’s Connect!

We value your voice. This ministry exists to serve our community well, and that starts by hearing directly from you. Your feedback helps us grow, improve, and respond to the real needs around us.

Complete the form below to share your input and consider joining our newsletter to stay connected with updates, resources, and opportunities to engage.

Together, we can strengthen the mental health and wellness of our community.

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Your Experience

Overall, how would you rate your experience with Counseling Connections?

How satisfied are you with…?

	Very Unsatisfied	Unsatisfied	Neutral	Satisfied	Very Satisfied
Our Customer Service	Very UnsatisfiedOur Customer Service Very Unsatisfied	UnsatisfiedOur Customer Service Unsatisfied	NeutralOur Customer Service Neutral	SatisfiedOur Customer Service Satisfied	Very SatisfiedOur Customer Service Very Satisfied
Our Intake Process & Scheduling	Very UnsatisfiedOur Intake Process & Scheduling Very Unsatisfied	UnsatisfiedOur Intake Process & Scheduling Unsatisfied	NeutralOur Intake Process & Scheduling Neutral	SatisfiedOur Intake Process & Scheduling Satisfied	Very SatisfiedOur Intake Process & Scheduling Very Satisfied
Our Counseling Services	Very UnsatisfiedOur Counseling Services Very Unsatisfied	UnsatisfiedOur Counseling Services Unsatisfied	NeutralOur Counseling Services Neutral	SatisfiedOur Counseling Services Satisfied	Very SatisfiedOur Counseling Services Very Satisfied
Our Facilities	Very UnsatisfiedOur Facilities Very Unsatisfied	UnsatisfiedOur Facilities Unsatisfied	NeutralOur Facilities Neutral	SatisfiedOur Facilities Satisfied	Very SatisfiedOur Facilities Very Satisfied
Our Referral Resources	Very UnsatisfiedOur Referral Resources Very Unsatisfied	UnsatisfiedOur Referral Resources Unsatisfied	NeutralOur Referral Resources Neutral	SatisfiedOur Referral Resources Satisfied	Very SatisfiedOur Referral Resources Very Satisfied

How likely are you to…?

	Very Unlikely	Unlikely	Neutral	Likely	Very Likely
Continue or Start Counseling	Very UnlikelyContinue or Start Counseling Very Unlikely	UnlikelyContinue or Start Counseling Unlikely	NeutralContinue or Start Counseling Neutral	LikelyContinue or Start Counseling Likely	Very LikelyContinue or Start Counseling Very Likely
Recommend Our Agency to Others in Need	Very UnlikelyRecommend Our Agency to Others in Need Very Unlikely	UnlikelyRecommend Our Agency to Others in Need Unlikely	NeutralRecommend Our Agency to Others in Need Neutral	LikelyRecommend Our Agency to Others in Need Likely	Very LikelyRecommend Our Agency to Others in Need Very Likely
Support Us Through Donating	Very UnlikelySupport Us Through Donating Very Unlikely	UnlikelySupport Us Through Donating Unlikely	NeutralSupport Us Through Donating Neutral	LikelySupport Us Through Donating Likely	Very LikelySupport Us Through Donating Very Likely

If you have any comments or ideas you would like to pass on to our administration, please let us know.

Let’s Connect!

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