TEMPLATE FOR THERAPISTS
Feedback Form
Most therapy feedback forms ask the wrong questions. They're either so vague that the responses aren't useful, or so clinical that clients feel like they're being evaluated rather than invited to reflect. What you actually want to know is: do my clients feel heard? Do they feel safe? Is the work landing the way I think it is? Are there things they're not saying in session that matter?
This template asks all of that—and it asks it in a way that feels like a conversation, not a performance review.
This is a full feedback form template for active clients in individual or group therapy. It combines quick rating scales with thoughtful open-ended questions to give you both quantifiable data and real insight into how clients are experiencing the work.
It's built for clinical use—not just for satisfaction scores. Questions cover the therapeutic relationship, cultural responsiveness, goal alignment, what's working, what isn't, and what clients haven't been able to bring into the room yet. There's also a section on logistics—scheduling, billing, communication—because practical barriers often show up in the clinical work and clinicians don't always know they're there.
Every question is voluntary. Every placeholder is marked in red. And there's a built-in "what happens next" section so clients know what their feedback will actually be used for—which is what makes them honest enough to give it.You're tired of not really knowing how your clients are experiencing the work—and especially if any of these sound familiar:
You supervise residents or interns and want structured client feedback as part of their evaluation
You've been curious how clients are experiencing your work but bringing it up in session always gets displaced by the actual session
You want to build a feedback culture into your practice without making it feel like a Yelp review
You practice with a cultural humility framework and want a form that actually asks clients whether that's landing
You're running a group practice and want a consistent feedback process across multiple clinicians
You've had a client end unexpectedly and you want better tools for surfacing concerns before they reach that point
You believe clients deserve a low-stakes way to say what's working and what isn't—and that good therapy means actually asking
1. Download and open—The template is a .docx file. Open it in Microsoft Word or Google Docs.
2. Replace the red brackets—Fill in your practice name, clinician details, and decide who will review responses: clinician only, supervisor included, or practice-wide.
3. Review the teal notes—Throughout the document, teal clinician notes explain the purpose of each section and flag decisions to make—which sections to keep, adapt, or remove. Delete all notes before finalizing.
4. Remove the clinician instruction page—This must be removed before sending to clients.
5. Send it—Through your EHR, by email, or as a printed form. Most clients can complete it in 15–20 minutes; the rating scales alone take under a minute.
6. Save as a PDF—When your edits are complete, save a final version as a PDF before sending to clients or uploading to your EHR.
7. Have it reviewed—Before distributing to clients, have your final version reviewed by your licensing board, malpractice carrier, and/or a licensed attorney. Requirements vary by state.
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