1.Client Name

2.I felt my culture, background, gender, race, 2SLGBTQIA+ identity, spirituality, other life circumstances were respected

No

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Yes

N/A

by reception

No

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Yes

N/A

by intake

No

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Yes

N/A

by my counsellor

No

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Yes

N/A

3.My counsellor and I worked on and talked about a plan for me.

No

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Yes

4.Overall, today's session was useful for me.

No

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Yes

5.Comments

6.Clicking yes indicates that you give your permission to KW Counselling Services to share your comments anonymously with funders and/or to use in promotional materials.

Yes

No