Client Survey

We are very grateful for the opportunity to have provided you with Christian counseling. We trust that the experience was caring, positive and helpful. In an effort to better communicate our services and reach out to others who may be looking for counseling, we share personal and anonymous testimonials from our clients on our website, in fund-raising correspondence and in our quarterly newsletter. All personal information is kept confidential. Please take few minutes to complete the questionnaire. If you need a personal response to a concern, please call the office at (708) 895-7310. Thank you for your assistance.

Client Survey

1. First name (optional):
2. In Therapy for:
3. Gender:
4. Age:
5. You can use my testimony in promotional materials. *
6. What prompted you to contact New Leaf (ex. lost loved one, marital issue, life transition)?
7. Did someone refer you to New Leaf?
8. Describe how counseling and/or New Leaf has helped you. Please share your "story".
9. What difference do you see in your life since receiving counseling?
10. What skills, coping tools, and resources have you gained? What do you look forward to now?
11. How can you help others with what you've learned?
12. What would you tell someone about New Leaf Resources?
13. How was your experience with our office support staff?
14. Additional Comments:

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