Client Feedback Form

To allow us to continuously improve our counselling programs, we invite you to provide honest feedback about your experience.
Please understand that completing this survey is voluntary and anonymous. Your feedback is used to improve the services we provide and we value your opinion.

Thank you for your time.

About You:

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* 1. Age:

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* 2. With which gender do you most identify?

Male

Female

Transgender male

Transgender female

Gender variant / non-conforming

Rather not answer

Other not listed (please specify)

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* 3. Have you sought counselling in the past?

Yes

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* 4. In which state did you access mental health support?

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* 5. In which suburb?

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* 6. Who received the service?

Myself

A child under 12 in my care

Our family

My partner and I

Other (please specify)

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* 7. Which type of service did you receive? (Please select all that apply).

Counselling

Care coordination and support

Counselling in an aged care facility

Child Services

Counselling that my workplace paid for

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* 8. Overall, how would you rate the mental health service you received?

Very Poor

Poor

Good

Very Good

Excellent

Very Poor

Poor

Good

Very Good

Excellent

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* 9. How likely are you to recommend this service to your friends or family if they needed it?

Very unlikely

Unlikely

Neither likely or unlikely

Likely

Very likely

Very unlikely

Unlikely

Neither likely or unlikely

Likely

Very likely

Client Feedback Form

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* 1. Age:

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* 2. With which gender do you most identify?

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* 3. Have you sought counselling in the past?

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* 4. In which state did you access mental health support?

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* 5. In which suburb?

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* 6. Who received the service?

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* 7. Which type of service did you receive? (Please select all that apply).

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* 8. Overall, how would you rate the mental health service you received?

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* 9. How likely are you to recommend this service to your friends or family if they needed it?

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* 10. In your opinion what were the best things about this service?

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* 11. If you could change one thing about our services, what would it be?