Skip to content
Check Screen Reader Mode to make this survey compatible with screen readers.
Check Screen Reader Mode to make this survey compatible with screen readers.
Counselling Feedback Form
1.
Service offered
Individual counselling
Couple/Family counselling
Academic coaching
Parental coaching
Other (please specify)
2.
My counsellor fostered a safe and trusting environment.
Strongly disagree
1 star
Disagree
2 stars
Neutral
3 stars
Agree
4 stars
Strongly agree
5 stars
N/A
Comments
3.
My counsellor has helped me identify my goals
Strongly disagree
1 star
Disagree
2 stars
Neutral
3 stars
Agree
4 stars
Strongly agree
5 stars
N/A
Comments
4.
My counsellor has helped me to reach my goals
Strongly disagree
1 star
Disagree
2 stars
Neutral
3 stars
Agree
4 stars
Strongly agree
5 stars
N/A
Comments
5.
My counsellor challenged me when/if that was appropriate.
Strongly disagree
1 star
Disagree
2 stars
Neutral
3 stars
Agree
4 stars
Strongly agree
5 stars
N/A
Comments
6.
My counsellor's approach has been a good fit for me so far
Strongly disagree
1 star
Disagree
2 stars
Neutral
3 stars
Agree
4 stars
Strongly agree
5 stars
N/A
Comments
7.
My overall level of satisfaction with the service provided by my
counsellor is
Strongly dissatisfied
1 star
Somewhat dissatisfied
2 stars
No strong feeling
3 stars
Somewhat satisfied
4 stars
Very satisfied
5 stars
Comments
8.
Based on my experience, I would recommend my counsellor to
others.
Yes
No
Is there anything else you'd like to share about your experience working with Naila?
9.
If you have not returned to counselling, please share why that is
I have reached my goals and feel that I have accomplished what I set out to
I haven't had time to book a session
I can't afford it
It's not a good time for me to continue
It was not good "fit" for me
n/a
Other (please specify)
10.
I am comfortable with the information I have provided here to be shared on the Journey with Naila website, with all identifying formation removed.
Yes
No
Other (please specify) / Comments
Current Progress,
0 of 10 answered