This form is for you to give me feedback on the work that we have done together. You are under no obligation to complete this form. All information on this form will remain confidential.
Your use, or not, of this form does not change the relationship we have.

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Tell me about your experience of working with me. Consider both what was helpful and unhelpful. This will help me to improve my practice. Don't forget about all the work that you have put in too.

Would you recommend me to others thinking about finding a therapist?

• Yes
• No

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