Counsellor Questionnaire Dear Counsillor, It is important for us to maintain and improve the service we provide, so we are asking all counsillors for their feedback. We would be grateful if you could take a few minutes to complete this form. Your DetailsName* First Last Email Date* 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? Very good Good Satisfactory Poor If poor, please comment with suggestions as to how it could have been improved if possible. 2. After you first spoke to Bereft. Was the wait for the first session with a counsellor? Very Quick Reasonable Too long for me Please add any further information/explanation: 3. Approximately how many sessions did you have with a Bereft counsellor? 4. Was this number sufficient? Yes No If not, please tell us your reason why not: 5. Did you feel supported by your Counsellor? Very well Well Just about Not at all If not, please tell us your reasons and any suggestions for improvement: Here are some possible ways in which you might have felt supported; please mark any which you think did apply in your situation. I felt relaxed with him/her I was able to tell her/him what was really on my mind He/she helped me to understand my situation better She/he gave me valuable information He/she had a proper regard for confidentiality She/he helped me to see things in a more positive way He/she helped me to make decisions 6. Overall, on a scale of 1–10, how did you find the counselling service offered by Bereft? (1=poor; 10=excellent) 1 2 3 4 5 6 7 8 9 10 7. Would you recommend Bereft to a friend or relative? Yes No 8. Would you contact us again should the need arise? Yes No Please add any further comments you may wish to make.Would you be happy for Bereft to use your comments anonymously in our literature or on our website? Yes No Thank you for your time. Yours sincerely, Kevin Scott Acting Chair, Practice Committee Δ
