Client Feedback Form

PRIVATE & CONFIDENTIAL

Your feedback is important to us, we would be grateful if you would complete this form at any time during or just after your therapy.

We are interested in your honest opinions, whether they are positive or negative, and therefore this is an anonymous procedure.

An important aspect of our administration is to monitor our Service User population and gain client feedback in order to offer the best service possible.

"*" indicates required fields

In addition to your recent counselling sessions at LIFE-FORCE, have you had counselling before?

Yes, at LIFE-FORCE

Yes, elsewhere

Was the Client Information Leaflet, that was provided on the first session, helpful?

Yes

Haven't read it

Was the website helpful?

Yes

Not visited

Any Comments:

Please indicate your ethnic origin:

Please indicate your religion:

Please indicate any special needs or physical learning disabilities:

Epileptic

Physical Injury

Walking Stick

Learning Disability

Blue Badge Holder

Other

None

Service Feedback

Please score the following points according to a scale of 5-1 where Excellent = 5, Good = 4, Average = 3, Fair = 2, Poor = 1 and make any comments or suggestions.

How did you find the general approach of the LIFE-FORCE office staff e.g. were they helpful and sensitive etc? How do you rate their overall professional approach?*

Comments:

After contacting LIFE-FORCE, how long did you wait for your first appointment? How do you rate this level of service?*

Comments:

How did you find the general approach of your counsellor e.g. warm, open, skilled? How do you rate their professional ability?*

Comments:

Upon reflection please rate to what extent you found the counselling to be beneficial, or not. Please comment accordingly.*

Comments:

How good did you find the Centre’s facilities, atmosphere, therapy rooms and the environment?*

Comments:

Rate how good overall you found the Service. Would you consider recommending the Service to others?*