Client Questionnaire

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Dear Bereft Client,

It is important for us to maintain and improve the service we provide, so we are asking everyone who has received one or more bereavement counselling sessions from us for their feedback. We would be grateful if you could take a few minutes to complete this form.

Your Details

DD slash MM slash YYYY

Your reply will be treated in strict confidence by the Practice Committee

Please answer the questions below. If you are unable to answer a question, just move on to the next one.

1. Was your first contact with Bereft?
2. After you first spoke to Bereft. Was the wait for the first session with a counsellor?
4. Was this number sufficient?
5. Did you feel supported by your Counsellor?
Here are some possible ways in which you might have felt supported; please mark any which you think did apply in your situation.
6. Overall, on a scale of 1–10, how did you find the counselling service offered by Bereft? (1=poor; 10=excellent)
7. Would you recommend Bereft to a friend or relative?
8. Would you contact us again should the need arise?

Would you be happy for Bereft to use your comments anonymously in our literature or on our website?
Thank you for your time.
Yours sincerely,

Kevin Scott
Acting Chair, Practice Committee