Submit Feedback

I am always seeking to improve my practice and better understand the impact of our work together. If you’ve worked with me, I invite you to offer feedback and to share your perspective about the process and your experience. Your input is invaluable and helps me continue to refine my approach. Feedback can be submitted anonymously, or you can grant permission to share your experience publicly to help others understand the power of the therapeutic process. Sharing your story may encourage others who are seeking healing to take the first step toward their own transformative journey.

Client Feedback Form: Sharing Your Experience

Thank you for taking the time to share your reflections about your therapeutic experience. Your insights may help others better understand what it's like to engage in therapy and how the process can support healing, growth, and self-awareness.

Please note: Sharing your feedback is entirely voluntary. Your participation will not affect your current or future therapeutic relationship.

I am committed to upholding your privacy, confidentiality, and autonomy in accordance with professional ethical guidelines

Consent to Share Feedback Anonymously

Please read and check the boxes below to indicate your consent:

I understand that my feedback may be shared anonymously for purposes of education, outreach, and public awareness, such as on a website, in presentations, or in written publications.

I understand that no identifying information (such as my name, specific dates, locations, or uniquely personal details) will be shared.

I have the right to decline to provide feedback and doing so will not affect my relationship with my therapist.

I understand that I may request to withdraw or edit my feedback at any time by contacting jcromerabp@gmail.com.

I give my permission for the content I share below to be edited slightly for grammar or clarity, so long as the meaning and tone remain intact.

Optional Demographics

Only complete this section if you’re comfortable. Your responses help provide context to others considering therapy.

Age

Gender

Your Reflections

What initially led you to seek therapy? 

What was your experience like in therapy?

What would you tell someone who is considering therapy or feeling uncertain about it?

Any other thoughts, metaphors, images, or insights you’d like to share about your experience?

Authorization

I acknowledge that by submitting this form, I authorize Jamie Cromer to share my feedback anonymously as described above.

Privacy and Ethics Statement

This feedback form is governed by ethical standards outlined in the National Association of Social Workers (NASW) Code of Ethics. We are committed to maintaining your confidentiality and will never disclose any information that could reasonably identify you.

JAMIE CROMER