Pre Session Form

For you as a valued client. The feedback section provides you with the opportunity yo give Pollin any comments and feedback about her, her service and/or the effectiveness of the program she shared with you. Please feel free to express your view, values and concerns in a constructive way so that we can address issues or suggestions brought to our attention.
For Pollin as a professional. Your truthfulness will help Pollin become aware of any areas that need attention so that she can continue to improve and provide the best level of service possible to all her clients. With your valuable feedback, Pollin will be able to determine if the standard of her service is up to your expectation.
For public awareness. This feedback also functions as a testimonial to be used on Pollin's website, digital platforms and/or educational and marketing materials. As you are already aware, due to the nature of her service, people are understandably initially reserved about beginning therapy. Your testimonial may help allay some reservations enough to encourage them to begin their personal journey as you have done so yourself.

Thank you for your time and support in completing this feedback.

What would you say about Pollin and the service she offers?

Is there anything you would like Pollin to know or be aware of? (Do you feel that Pollin dealt with you and your issues with respect and care? Are there any suggestions you'd like to share with Pollin?)

Can you recall, what brought you to seek therapy in the first place? How do you feel about that now?

Have aspects of your life changed or improved as a result of your time with Pollin? If so, how or what?

What were the most useful or memorable parts of the therapy for you?

Is there any additional comments you would like to share?

I hereby confirm that (please tick each point as you read them)

I give my consent for Pollin Kamell to use relevant aspects of my feedback as a testimonial or reference in her website and education/consumer materials.
I understand that my privacy and confidentiality will be maintained.

*** Pollin understands the value of your privacy, especially those of you in prominent positions. We want to assure you that your confidentiality is fully respected. However, for administration purposes, it would be appreciated if you can please include your name and contact details so that Pollin can contact you if she wishes to clarify any details with you. Any references to your feedback will only refer to you as your preferred reference name. Please enter that below. It can be just your first name, your initials or your full name (if you are comfortable with that).

Name (for admin purposes only)

Preferred name to be attached to your testimonial. (This can be your full name, your first name. or just your initials)

City or Country

Contact number (for admin purposes only)

Pollin understands that you value your privacy, especially those of you in prominent positions. We want to assure you that your confidentiality is fully respected. However, for administration purposes, it would be appreciated if you can please include your name and contact details so that Pollin can contact you if she wishes to clarify any details with you.

Any references to your feedback will only refer to you as your preferred reference name. Please enter that below. It can be just your first name, your initials or your full name (if you are comfortable with that).

PK Kamell

Pollin Kamell - CHIT Developer

Client Feedback and Testimonial Form