THRIVE COUNSELLLING - CLIENT SATISFACTION QUESTIONNAIRE

Page1 / 1

100% of survey complete.

Please take a few minutes to evaluate our services. Your responses will be treated in the strictest confidence.

Please blacken the box that best describes your evaluation of the quality and impact of the counselling you received.

Question Title

* 1. The amount of service offered was satisfactory

Yes

No

Question Title

* 2. The response time to my request for service was acceptable

Yes

No

Question Title

* 3. The effectiveness of counselling

As a result of counselling:

	Significantly Improved	Improved	Remained the same	Became Slightly Worse	Became Worse
a) My ability to deal with the situation that brought me to THRIVE…	a) My ability to deal with the situation that brought me to THRIVE… Significantly Improved	a) My ability to deal with the situation that brought me to THRIVE… Improved	a) My ability to deal with the situation that brought me to THRIVE… Remained the same	a) My ability to deal with the situation that brought me to THRIVE… Became Slightly Worse	a) My ability to deal with the situation that brought me to THRIVE… Became Worse
b) My quality of life has…	b) My quality of life has… Significantly Improved	b) My quality of life has… Improved	b) My quality of life has… Remained the same	b) My quality of life has… Became Slightly Worse	b) My quality of life has… Became Worse
c) My situation at work has… (if applicable)	c) My situation at work has… (if applicable) Significantly Improved	c) My situation at work has… (if applicable) Improved	c) My situation at work has… (if applicable) Remained the same	c) My situation at work has… (if applicable) Became Slightly Worse	c) My situation at work has… (if applicable) Became Worse

Question Title

* 4. The quality of counselling

	Very High	High	Medium	Low	Very Low
a) My satisfaction with counselling has been...	a) My satisfaction with counselling has been... Very High	a) My satisfaction with counselling has been... High	a) My satisfaction with counselling has been... Medium	a) My satisfaction with counselling has been... Low	a) My satisfaction with counselling has been... Very Low
b) My satisfaction with the agency....	b) My satisfaction with the agency.... Very High	b) My satisfaction with the agency.... High	b) My satisfaction with the agency.... Medium	b) My satisfaction with the agency.... Low	b) My satisfaction with the agency.... Very Low
c) My satisfaction with my counsellor...	c) My satisfaction with my counsellor... Very High	c) My satisfaction with my counsellor... High	c) My satisfaction with my counsellor... Medium	c) My satisfaction with my counsellor... Low	c) My satisfaction with my counsellor... Very Low
d) My satisfaction with other staff members…	d) My satisfaction with other staff members… Very High	d) My satisfaction with other staff members… High	d) My satisfaction with other staff members… Medium	d) My satisfaction with other staff members… Low	d) My satisfaction with other staff members… Very Low

Question Title

* 5. I would recommend Thrive Counselling:

Yes

No

Question Title

* 6. What I like best about the service:

Question Title

* 7. A change that THRIVE could consider:

Question Title

* 8. Additional comments?

Question Title

* 9. I am willing to have my comments used anonymously in information on Thrive Counselling (for example, on the website)

Yes

No

Question Title

* 10. If you were dissatisfied with the service you received and would like a response to your concerns, please specify below, and provide an address and telephone number you can be reached at, if different from your file. The Director of Programs or Executive Director of Thrive Counselling will contact you personally about your concerns.

Name:

Phone Number: