Client | Provider
Evaluation Form

This form is to gather relevant feedback in order to understand how both the client and provider experienced this professional relationship. Our hope is to assure quality services and be notified by either party in the event something went awry. By sharing this information with us, we will be able to better serve future participants and providers. We appreciate you taking the time.

Allow for 10-15 minutes to complete.

Client First Name

Client Last Name

Provider First Name

Provider Last Name

What service was provided?

What was the beginning and end date of this service? (Please also indicate amount of sessions if applicable.)

Start date

End date

Number of sessions

What was the goal for this professional service?

On a scale of 1 to 5, please indicate the perceived level of positive impact/effectiveness achieved. Select an option *

Ineffective/no to negative impact made

Extremely effective/positive life-changing impact

Describe your experience as reflected in your previous answer here.

As the client, what is your most significant take-away from this experience? And, what is your next step for your soul care ?

On a scale of 1 to 5, how likely are you to work with this person or participate in this service again? *

Highly unlikely/never again

Highly likely/would recommend

What other relevant information would be valuable for us to know so that the scholarship partnership program can continue to flourish?

It is important that our donors hear about the impact they are making through this scholarship program. Please make a statement of gratitude that we can share with our financial partners. To the level of your comfort, include either your initials, full name, and/or title, otherwise, we will respect your anonymity. Thank you!

Thank you! We have received your feedback.

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928.671.1725

Client | Provider Evaluation Form

What was the beginning and end date of this service? (Please also indicate amount of sessions if applicable.)

Ineffective/no to negative impact made

Extremely effective/positive life-changing impact

Highly unlikely/never again Highly likely/would recommend

HOME ABOUT US RETREATS RESOURCES DONATE

SUBSCRIBE TO OUR NEWSLETTER

928.671.1725

Client | Provider
Evaluation Form

Highly unlikely/never again

Highly likely/would recommend

HOME
ABOUT US
RETREATS
RESOURCES
DONATE

SUBSCRIBE TO
OUR NEWSLETTER