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Client Feedback Form

Client Information

Practitioner Information

Session

Invocation

Conversation

Activation

Integration:

Please rate how you felt about the following during the session:

Not safe
Completely safe
Judged
Non judgement
Felt unheard
Felt heard

Please rate how you felt about the following during the session:

Not good
Amazing
Not effective
Very effective
No time at all
Way too much time
Wont use
Exactly what i needed

“Thank you for submitting this form. Your information has been received and your Practitioner will follow up with you directly, if necessary.”