Counselling Client Feedback Form

About the Working Relationship With Your Counsellor

Strongly AgreeSomewhat AgreeNo Strong FeelingSomewhat DisagreeStrongly Disagree

My counsellor listened to me effectively.

My counsellor understood things from my point of view.

My counsellor focused on what was important to me.

My counsellor accepted what I said without judging me.

My counsellor showed warmth toward me.

My counsellor fostered a safe and trusting environment.

My counsellor began and finished our sessions on time.

My counsellor followed my lead during our sessions whenever that was appropriate.

My counsellor provided leadership during our sessions when/if that was appropriate.

My counsellor challenged me when/if that was appropriate.

About the Results of Working With Your Counsellor

Strongly AgreeSomewhat AgreeNo Strong FeelingSomewhat DisagreeStrongly Disagree

The sessions with my counsellor helped me with whatever originally led me to seek counselling.

Any changes which might have occurred in me as a result of my counselling have been positive and welcome.

Overall Satisfaction

Very SatisfiedSomewhat SatisfiedNo Strong FeelingSomewhat DissatisfiedStrongly Dissatisfied

My overall level of satisfaction with the service provided by my counsellor is:

Your Recommendation

YesNo

Based on my experience, I would recommend my counsellor to others.

Use of Information

YesNo

I give permission the feedback I have provided to be shown on the Living Therapy website, with any changes made to preserve the anonymity of all individuals and institutions involved.

About the Working Relationship With Your Counsellor

Strongly AgreeSomewhat AgreeNo Strong FeelingSomewhat DisagreeStrongly Disagree

About the Results of Working With Your Counsellor

Strongly AgreeSomewhat AgreeNo Strong FeelingSomewhat DisagreeStrongly Disagree

Overall Satisfaction

Very SatisfiedSomewhat SatisfiedNo Strong FeelingSomewhat DissatisfiedStrongly Dissatisfied

Your Recommendation

YesNo

Other Comments

Use of Information

YesNo