Counselling Service Evaluation (Adult Client)

Counselling Service Evaluation Form (Adults)

About you(Required)

I received bereavement counselling

I received life-limiting illness counselling

How helpful was the support you received?(Required)

Additional comments

What difference (if any) has the support made to you?

Thinking about your counsellor/support worker, did you feel understood?(Required)

Thinking about your counsellor/support worker, did you feel accepted and valued?(Required)

Thinking about your counsellor/support worker, did you find him/her friendly and supportive?(Required)

Additional comments

At the end of your initial assessment, did you have a full understanding of how you would be supported?(Required)

Were you satisfied with how quickly a service was provided (e.g. responding to telephone calls, assessment, beginning of support)(Required)

Additional comments

Do you feel you had the right number of sessions?(Required)

Additional comments

Have you been informed about further support should you, or your family, require it in the future?(Required)

Overall, were you satisfied with the service provided?(Required)

Additional comments

Would you recommend this service to others?(Required)

Do you have any other comments or suggestions you would like to make about the service?

This form is anonymous however if you are happy to share your feedback further, please complete the sections below.

In the unfortunate event that you have any concerns about the service you received, would you like the Counselling Services Manager to contact you?

Are you happy for us to share your feedback with your counsellor/support worker?

Are you happy for us to share your comments anonymously in publicity?

Would you be happy to share your feedback more widely - to help us promote our services in the local press or through social media?

Name (optional)

First Last

Phone (optional)

Email (optional)