Client – Counselor Feedback Form

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Thank you for taking the time to complete this form. It is a valuable tool for helping to improve the services offered to others and for helping your counselor’s professional development.
Likert Scale
Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
My counselor listened effectively.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
My counselor understood my point of view.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
My counselor began and ended sessions on time.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
My counselor challenged me when/if appropriate.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
My counselor focused on what was important to me.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
My counselor fostered a safe and trusting environment.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
My counselor accepted what I said, without judging me.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
My sessions helped me reach the results I wanted to by engaging in counseling.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
My counselor followed my lead, or provided leadership, as was appropriate or desired.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
On a scale of 1 to 10, with 10 being the highest, My overall level of satisfaction with my counselor is:
I would recommend my counselor to others
Your name is not required but appreciated