Counseling Date:

We would greatly appreciate your assistance in helping us improve the quality of our counseling by providing your candid feedback on the counseling session you just experienced. We ask that you take a few minutes to answer a couple of simple questions that can guide our future efforts. You need not sign the form if you choose not to. Please try to be as specific as you can:

    Was the counseling session of help to you? Yes  No

    Was the advice you received of use to you? Yes  No

    Did the session address the areas of your concern? Yes  No

    Are you planning or would you like an additional counseling session?  Yes  No

    Would you like a counselor to call you to see if you have additional areas of concern? Yes  No

What did you like about the session?

What did you not like about the session?

What topics would you like to see us give seminars on?

If you would like a response, please tell us how to get in touch with you:

Name
E-mail
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Please contact me as soon as possible regarding this matter.