* 1. Date


* 2. Approximately, how many sessions have you had?

* 4. Did you feel heard, understood and respected by your counsellor?

* 5. Did you feel comfortable speaking with your counsellor?

* 6. Was your counsellor’s approach a good fit for you?

* 7. Were you able to work on and talk about what you wanted?

* 8. Overall, has your quality of life improved since coming to counselling?

* 9. Since coming to counselling, do you feel more able to deal with challenges in your life?

* 10. Do you feel safer/more protected from harm?

* 11. What do you feel you benefitted most from?

* 12. Is there anything that could be done differently in counselling?

* 13. Is there any feedback you would like to give to your counsellor?

* 14. Do you have any further comments about your counselling experience at the service?

Thank you
We appreciate your feedback about our counselling service. Please do not hesitate to contact us with any further suggestions regarding ways we can improve our service to you.