Which treatment did you have?
After your appointment
Collect patient feedback after dental appointments to understand experiences and improve clinic services.
See every questionNew client intake
Collect initial details, understand needs, and schedule first sessions for new counselling clients.
Hosted by Diane · 8 questions
Every question in this template
Diane asks each of these questions on video, in this order.
- 01
What kind of support are you looking for?
Multiple choice
Diane says: “What kind of support are you looking for right now?”
Individual therapy · Couples therapy · Family therapy · Not sure yet
- 02
What brings you here?
Video, voice or text answer
Diane says: “In whatever way feels comfortable, tell me a little about what brings you here.”
- 03
Have you been in therapy before?
Yes or no
Diane says: “Have you worked with a therapist or counsellor before?”
- 04
How would you like to meet?
Multiple choice
Diane says: “Would you prefer to meet in person or online?”
In person · Online video · Either works
- 05
When would you like to start?
Date
Diane says: “When would you like to have your first session?”
- 06
Confidentiality
Consent
Diane says: “What you share stays within our care team. Please confirm you've read this.”
- 07
Your contact details
Contact details
Diane says: “Lastly, how can we reach you to set up your first session?”
- 08
What helped, and what didn't?
Long answer
Diane says: “What helped last time, and what didn't feel right for you?”
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Where is the main problem?
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See every questionReady to transform feedback?
They won't type it.
But they'll show it.
Start collecting real feedback in video. See what your customers actually think and feel.