Counselling Evaluation Form

Counselling Evaluation Form
Date

DayMonthYear
First Name
Given name
Last Name
Surname
Gender :
Name of Counsellor :
Session Type (You may tick more than one)
Please indicate your responses to the following questions :

1. I was able to book the appointment without any difficulty

	1	2	3	4	5

1 is Disappointing, 5 is Excellent

2. The staff who attended to me administratively was helpful

	1	2	3	4	5

1 is Disappointing, 5 is Excellent

3. The counsellor created a safe environment for me to share my struggles

	1	2	3	4	5

1 is Disappointing, 5 is Excellent

4. I felt understood, supported, and cared for.

	1	2	3	4	5

1 is Disappointing, 5 is Excellent

5. The counsellor was able to assess and explain what was troubling me.

	1	2	3	4	5

1 is Disappointing, 5 is Excellent

6. The counsellor guided me to establish clear goals to resolve my issues(s).

	1	2	3	4	5

1 is Disappointing, 5 is Excellent

7. How did the counselling sessions benefit you? (You may tick more than one)

8. How satisfied are you with the overall counselling experience?

	1	2	3	4	5

1 is Disappointing, 5 is Excellent

9. Is this the first time you are receiving counselling?
10. Is this your first experience with Focus on the Family Singapore?
11. Would you recommend our counselling service to others?
12. Please share how the sessions have benefitted you :
13. I allow my comment (de-identified) to be quoted by Focus on the Family Singapore.
14. I would like information on (You can tick more than one)
15. If you are not on our mailing list :
Thank you for your feedback! We wish you the best as you continue to author the

future chapters of your life.
Should be Empty: