Time to Listen logo

We specialise in working with children, young people and families, but also provide counselling for adults

Counselling Feedback Form

Private and Confidential

In order to help us evaluate the counselling service we need your feedback. Your answers will be treated confidentially and you do not have to give your name. Please return this questionnaire in the envelope provided. Thank you very much for your help.

1. What do you think about where the counselling takes place?

 

Agree Strongly

Agree

Disagree

Disagree Strongly

I think the location is easy to find

I think the location is convenient

I think the room is comfortable

I think the room is private

I think the room is quiet

2. Did you feel you got your appointment quickly enough?

Yes No

If 'No', how long did you have to wait?

3. Did you check us out on the website?

Yes No

If 'Yes' what did you think about it?

4. We would like some information on your relationship with your counsellor.

First name of Counsellor

 

Agree Strongly

Agree

Disagree

Disagree Strongly

My first impression of my counsellor was a positive one

I feel my counsellor is easy to talk to

I feel my counsellor is someone who really listens

I feel my counsellor is supportive

I feel my counsellor is someone who gives me confidence

I feel my counsellor is someone who has helped me deal with some difficult issues

I feel my counsellor is someone who does not judge me

5. How helpful have you found the counselling?

It helped me to:-

Agree Strongly

Agree

Disagree

Disagree Strongly

See things more clearly

Understand my problems

Understand myself better as a person

Start to make some changes

Feel better

Feel more confident about myself

6. If you needed to would you use the counselling service again in the future?

Yes No

7. Would you recommend the counselling service to other young people in need of help?

Yes No

8. Was there anything you disliked about the counselling?

9. What do you think could improve the counselling service?

10. Did you check us out on the website?

Yes No

If Yes what did you think about it?

Would you be willing for your comments to be placed on our website page?

Yes No

Any Further Comments that you would like to make?