Women’s Counselling Evaluation * 1. Date Date DD / MM / YYYY * 2. Approximately, how many sessions have you had? * 3. What type of counselling session/s did you have? Onsite Offsite Phone Other (please specify) * 4. Did you feel heard, understood and respected by your counsellor? Not at all Somewhat Moderately Mostly Absolutely Not at all Somewhat Moderately Mostly Absolutely * 5. Did you feel comfortable speaking with your counsellor? Not at all Somewhat Moderately Mostly Absolutely Not at all Somewhat Moderately Mostly Absolutely * 6. Was your counsellor’s approach a good fit for you? Not at all Somewhat Moderately Mostly Absolutely Not at all Somewhat Moderately Mostly Absolutely * 7. Were you able to work on and talk about what you wanted? Not at all Somewhat Moderately Mostly Absolutely Not at all Somewhat Moderately Mostly Absolutely * 8. Overall, has your quality of life improved since coming to counselling? Not at all Somewhat Moderately Mostly Absolutely Not at all Somewhat Moderately Mostly Absolutely * 9. Since coming to counselling, do you feel more able to deal with challenges in your life? Not at all Somewhat Moderately Mostly Absolutely Not at all Somewhat Moderately Mostly Absolutely * 10. Do you feel safer/more protected from harm? Not at all Somewhat Moderately Mostly Absolutely Not at all Somewhat Moderately Mostly Absolutely * 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 youWe 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. Done
