Feedback Form

Thank you for choosing PS COUNSELLING SERVICES for your
counselling needs. Your feedback is essential to help me
improve the services and better meet the needs of my clients.
I kindly request you take a few moments to complete this
survey. Your responses will remain confidential and greatly
appreciated.

Your Name

First NameLast Name

Your Email

example@example.com

Date

Please evaluate your counselling experience at PS COUNSELLING SERVICES:

	Very Bad	Bad	Neutral	Good	Excellent
How would you rate the professionalism of your counsellor?
How was the level of empathy and understanding demonstrated by your counsellor?
How helpful were the counselling sessions in addressing your concerns?
How would you rate the comfort and safety of the counselling environment?
How well was the level of confidentiality maintained during your sessions?
How helpful were the strategies and techniques recommended by your counsellor helpful?
How do you rate changes in your well-being or coping mechanisms because of the counselling?

	Not Satisfied	Somewhat Satisfied	Satisfied	Very Satisfied
Were you satisfied with the administrative support provided (e.g., communication, easy of booking, paperwork)?

	Not Likely	Somewhat Likely	Likely	Very Likely
Based on your experience, how likely are you to recommend our counselling service to a friend or family member?

On a scale of 1 to 5 (1 the worst, 5 the best), how would you rate your overall experience with our counselling service?

1 is Worst, 5 is Best

Please explain why your counselling ended:

I have finished my therapy and attained my goals, so I felt that I didn't need to carry on.My counsellor was fully booked and couldn't attend to me.I simply could not afford it.It is not the right time for me to carry on due to other circumstances.My counsellor was not an excellent match for me.

Is there anything else you would like to share that would help make my services more effective for you or others?

Thank you for you time.

Paulina Stanek
Registered counsellor & Practice founder
BA Humanities, PGDip Counselling psychology, MSc Psychology

PS COUNSELLING SERVICES
516A Dorset Road, Croydon South 3136 VIC
info@pscounselling.com
0475703777
www.pscounselling.com