Skip to main content
Find A Therapist
About BLHF
Programs
Events
Resources
Get Involved
News
Blog
More
Give Joy
Menu
Find A Therapist
About BLHF
Programs
Hangouts
Scholarship Fund
Events
Resources
Community Resources
Provider Resources
Educator Resources
Get Involved
Our Partners
Press
Blog
Partnership Client Survey
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
Name
*
First
Last
Client ID
*
This is NOT your SSN. Refer to the registration sign-up email for your client number, please use the full ID numbers and letters.
Email Address
*
Your Therapist / Mental Health Provider
*
-Please Choose Your Provider-
Maryland: Asia Vianna Leak | Love Yoga Studio
Maryland: Dr. Amanda Davis-Buie, PhD, LPC, LBS, NCC|Strength, Love, and Motivation, LLC
Maryland: Dr. Leeshe Grimes, LCPC|Elevated Minds
Maryland: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Maryland: Isaac Collins, LMSW|Collins & Collins Counseling Services
Maryland: Marcia Chichester | Dr. Marcia P. Chichester, LCSW, P.L.L.C.
Maryland: The MECCA Group, LLC
Maryland: Petrina L. Williams LICSW, LCSW-C | Miracles In Motion Therapy and Consulting LLC
Maryland: Pieces of Me Behavioral Health, LLC
Maryland: Razaria Best, LMFT|Knowledge Therapy For Thoughts, LLC
Maryland: Thrive Counseling Teletherapy Services
Maryland: Transcend Clinical Services, Inc
Maryland: Twanna Carter, LPC | JBC Counseling & Consulting, LLC
Texas: Abe Turner, MA, LPC-A | The Weekend Therapist
Texas: Amber Boyd, LMFT | Healing Through Authenticity
Texas: Angela L. Mull | Angela L. Mull Psychotherapy Creating Beautiful Minds
Texas: Valerie Kuykendall-Rogers | Ascent Psychotherapy Center
Texas: Brittany Woodley, LCSW | The Empowering Space
Texas: Calvary Sampson | Calvary De'Rosa Counseling and Consulting
Texas: Chikeitha Owens M.A LPC | Abundance of Hope Counseling Service
Texas: Dr. Mel McGee | Covington-McGee Christian Counseling
Texas: Doreatha Page | Rooted In Hope Therapy
Texas: Deitra Baker | Deitra Baker, LMFT
Texas: Demetryas Pennegraph | Demetryas Pennegraph, MS-Mental Health Counseling- R.E.A.L. Wellness (Restoring, Educating And Leading)
Texas: Dr. Catina Miller | Mindful Wellness Reset: Relax, Release & Renew, PLLC
Texas: Dr. Diona Shelton, LCSW | New Beginnings Counseling Services
Texas: Dr. Seleena Smith | REAL Liberation Coaching & Consultation Services
Texas: Janee V. Henderson | Janee V. Henderson, M.Ed., LPC
Texas: Jason Prendergast | Edify Counseling Group LLC
Texas: Glenda Demas LPC, ACTP | Pearls of Change Wellness
Texas: Isaac Collins, LMSW | Collins & Collins Counseling Services
Texas: Kimberly Ann Parker | Kimberly Ann Parker, Revive to Thrive Wellness, PLLC
Texas: Krista Woods | Krista Woods, M.S.W., LCSW
Texas: Omolola Taiwo | Omolola Taiwo, NCC, LPC
Texas: Tanesha Graham | Pieces of Me Behavioral Health
Texas: Rashan Carter, LCSW | Passion & Purpose Fulfilled
Texas: Rayvene Whatley | Rayvene Whatley, LPC, LPC-S
Texas: Shameka Collins, LMSW | Collins & Collins Counseling Services
Texas: Shawnnell Batiste, LPC | Choosing Empowerment
Texas: Andranique Goodman | The Inner Mind Counseling & Wellness
Please use the drop-down menu to choose your Provider.
Session Date / Time
*
Date
Time
Your Experience
*
Rate 1 out of 5
Rate 2 out of 5
Rate 3 out of 5
Rate 4 out of 5
Rate 5 out of 5
Overall, how would you rate your experience with us?
How satisfied were you with
*
Unsatisfied
Neutral
Very Satisfied
Your Treatment
Unsatisfied
Your Treatment Unsatisfied
Neutral
Your Treatment Neutral
Very Satisfied
Your Treatment Very Satisfied
Timely Session Scheduling
Unsatisfied
Timely Session Scheduling Unsatisfied
Neutral
Timely Session Scheduling Neutral
Very Satisfied
Timely Session Scheduling Very Satisfied
Technology
Unsatisfied
Technology Unsatisfied
Neutral
Technology Neutral
Very Satisfied
Technology Very Satisfied
Program Meeting Your Needs/Expectations
Unsatisfied
Program Meeting Your Needs/Expectations Unsatisfied
Neutral
Program Meeting Your Needs/Expectations Neutral
Very Satisfied
Program Meeting Your Needs/Expectations Very Satisfied
Number of Sessions Offered
Unsatisfied
Number of Sessions Offered Unsatisfied
Neutral
Number of Sessions Offered Neutral
Very Satisfied
Number of Sessions Offered Very Satisfied
How likely are you to
*
Unlikely
Neutral
Likely
Schedule a new appointment
Unlikely
Schedule a new appointment Unlikely
Neutral
Schedule a new appointment Neutral
Likely
Schedule a new appointment Likely
Recommend this provider to others
Unlikely
Recommend this provider to others Unlikely
Neutral
Recommend this provider to others Neutral
Likely
Recommend this provider to others Likely
Recommend BLHF Services to others
Unlikely
Recommend BLHF Services to others Unlikely
Neutral
Recommend BLHF Services to others Neutral
Likely
Recommend BLHF Services to others Likely
Participate in another program like this
Unlikely
Participate in another program like this Unlikely
Neutral
Participate in another program like this Neutral
Likely
Participate in another program like this Likely
Have you scheduled a follow-up visit with this provider?
*
Yes
No
If not, do you plan to schedule a follow-up visit with this provider?
*
Yes
No
How was your experience?
*
We're sorry you if did not have a good experience. Please let us know how we can do better.
Would you like to share your experience publicly as a testimonial of how BLHF free mental wellness support helped you?
Yes
No
Comment
Submit
Subscribe to the Newsletter
Email
CAPTCHA
Δ