1.Indicate the type of services you received from this therapist:

Evaluation

Testing

Individual Counseling

Case Management

Group counseling

2.Does/did the counselor/CM help you achieve the purpose for which you sought counseling?

Yes

No

3.Does/did the Counselor/CM help you obtain skills that will help you handle future problems?

Yes

No

4.Does/did the counselor/CM understand your needs?

Yes

No

5.Does/did the counselor/ CM involve you in the treatment planning (such as treatment goals and frequency of appointments)?

Yes

No

Other (please specify)

6.Do you fully understand the handbook?

Yes

No

7.Do you know how to gain access to another copy of the handbook?

Yes

No