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Counselling Evaluation Form

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We’d really value your thoughts.

If you’ve used one of our services, please take a moment to share your feedback with us.

Your experience helps us learn what’s working well and where we can improve, so we can continue to provide the best possible support.

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Thank you for helping shape our service.

Counselling Service Evaluation Form

It is important to us to know what you thought about the service you received.  This feedback will help us make sure we keep delivering a service which meets the needs of people we work with.   



Please select the box which is closest to your answer

How satisfied were you with your Counsellor?
Very Satisfied
Satisfied
Neutral
A bit
Not at all Satisfied
How satisfied were you with the service provided by the counsellor
Very Satisfied
Satisfied
Neutral
A bit
Not at all Satisfied
How satisfied are you that the confidentiality contract was fully explained and kept?
Very Satisfied
Satisfied
Neutral
A bit
Not at all Satisfied
How satified were you with the flexiblity of the counselling? (appointment times, days)
Very Satisfied
Satisfied
Neutral
A bit
Not at all Satisfied
How satisfied are you that you were listened to?
Very Satisfied
Satisfied
Neutral
A bit
Not at all Satisfied
How satisfied are you that your needs were understood?
Very Satisfied
Satisfied
Neutral
A bit
Not at all Satisfied
How satisfied are you that your needs were met?
Very Satisfied
Satisfied
Neutral
A bit
Not at all Satisfied
How satisfied were you with the number of sessions you had?
Very Satisfied
Some what
not really
Not at all
I felt that i could be myself
Strongly Agree
Agree
Disagree
Strongly Disagree
I felt like i understood myself better at the end
Strongly Agree
Agree
Disagree
Strongly Disagree
*I would recommend this service to others
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Please complete this section if you are exiting from ASSTBM Services
I have successfully dealt with the problems I wanted to
I need a break from services – I was finding it too hard right now
I don’t feel comfortable with the member of staff
I am no longer being forced to go
I feel I can deal with the problems myself
I don’t feel I was getting anywhere
I am now receiving support from a specialist service

Thank you for taking the time to complete this form. Your response is anonymous and confidential, however if you have raised any issues which you would like followed up, please insert your details below: 

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