Client Feedback Form
Please fill in the form below and press the submit button to send your feedback.
| Client number: | |
| Gender: | Male Female |
| Date of last session: | / / |
| Rate contact with office staff: | Excellent Good Fair Poor |
| Time between initial CC and commencing on-going counseling: |
Excellent Good Fair Poor |
| Rate counsellor's understanding of situation: | Excellent Good Fair Poor |
| Effect counselling has had on understanding yourself: | Excellent Good Fair Poor |
| Effect counselling has had on understanding your partner: |
Excellent Good Fair Poor |
| Effect counselling has had on changing your relationship: | Excellent Good Fair Poor |
| Do you consider your experience of counselling at Relate worthwhile?: |
Yes No |
| Would you recommend Relate?: | Yes No |
| Client suggestions/comments: | |