Lisa Johnson, PhD, LMFT
Marriage and Family Therapy services for individuals, couples and families
“All families have strengths, what are yours?”
Please complete this form to provide valuable feedback for your therapist, Lisa Johnson, on how helpful the therapy process has been for you. If you are continuing in therapy with Lisa, you may want to bring the completed form with you to your next session and talk with her about it. If you have chosen to discontinue therapy with Lisa Johnson, the information provided can be a useful way to communicate what has been helpful for you, or not, and why you have chosen to discontinue therapy at this time.
To complete the form electronically, simply tab from field to field. Or, you may print the form out and fax or mail to us. See complete sending options at the bottom of this form.
Feedback Form
1.Please rate the degree to which therapy has been helpful for you, in terms of getting help on what you wanted help with.
Very Dissatisfied Dissatisfied Satisfied Very Satisfied
2.Please rate how much benefit you believe the therapy process has had for you in terms of helping you to get a better picture of your situation and choices that you have.
No Increased Insight Some Increased Insight Much Insight
3.Please rate the extent that the therapy process has helped you to learn and/or practice new behaviors, such as coping skills, or learning new ways of interacting with others.
No New Skills Some New Skills Many New Skills
4.Please rate the degree to which you felt comfortable in sharing personal, confidential information with Lisa Johnson.
Total Distrust Some Distrust Some Trust Total Trust
5.Please rate your perception of how much of an interest Lisa Johnson took in your situation.
Totally Disinterested Mildly Disinterested Neither Disinterested nor Interested
Interested Very Interested
6.Please rate, overall, how you felt about the therapy process with Lisa Johnson.
Very Negative Negative Positive Very Positive
7.Please rate whether you would want to see Lisa Johnson again in the future.
Very Unlikely Not Likely Likely Very Likely
8.Would you accept a referral from Lisa Johnson to another Therapist (as compared to would you want to find another therapist without the involvement of your current Therapist)?
Definitely Not Probably Not Not Sure Probably Yes Definitely Yes
9.Please rate how likely you would be to see a Therapist in the future.
Definitely Not Probably Not Not Sure Probably Yes Definitely Yes
10.Please rate how confident you are now in dealing with life’s issues and challenges.
Totally Unconfident Unconfident Neither Confident Totally Confident
11.Would you give permission for the comments in this evaluation to be used for marketing purposes?
Yes No
If you answered yes to #11, please provide the following:
Name:
Email:
Comments
Please write any other comments you would like to make.
Thank you for taking time to complete our feedback form!
Please return your form by using a method below:
Via email attachment to
Via fax to: (505) 266-1440
Mail to: Administrative Assistant to Dr. Lisa Johnson
3214 Purdue Place NE
Albuquerque, NM 87106