Client Feedback

Please submit any comments, concerns, or other feedback below.

You may submit feedback anonymously if you wish. Please note:

Your feedback will not be shared with your therapist unless you select an option below indicating otherwise.

You will not be contacted about your feedback by a director of the practice unless you select an option indicating that you would like to be contacted and provide the date and time of your most recent appointment.

If your therapist is a director of the practice (Dr. Alice Thornewill or Dr. Suraji Wagage), only the director who is not your therapist will review your feedback and contact you if you indicate that you would like to be contacted.

My Therapist
If you have seen and would like to comment on more than one therapist, please submit a new feedback form for each therapist (past or present).
Would you like a director of the practice to contact you about your feedback? (Select all that apply)
Would you like your feedback to be shared with your therapist?
For example: 10/31/22, 2PM EST