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Counselling Feedback Form

Client Evaluation Form

We invite you to evaluate the service you have received.

Note:

  • Your identity is always kept confidential unless you give your permission otherwise
  • The information that you provide should be given voluntarily
  • There is no requirement to record your name on this form

If you have any queries, please contact:

EAPworks
PO Box 15070
Auckland 0640
09 625 6950 or 0800 SELF HELP
info@eapworks.co.nz

Please complete the following:

Date

My Company

Town/City

Counsellor

My appointment was made in a reasonable time
 Strongly Agree Agree Unsure Disagree Strongly Disagree

I felt that the counsellor understood my situation
 Strongly Agree Agree Unsure Disagree Strongly Disagree

I feel that the counselling session was helpful in dealing with the issues
 Strongly Agree Agree Unsure Disagree Strongly Disagree

The counselling session will help me improve my wellbeing and productivity
 Strongly Agree Agree Unsure Disagree Strongly Disagree

I would recommend this service to other employees
 Strongly Agree Agree Unsure Disagree Strongly Disagree

Other Comments

This section is optional

Your feedback

Are there any comments of suggestions you would like to make about your workplace environment?
The information you provide will be collated with other comments and suggestions and be included as part of a confidential and neutral feedback report to your company.

My suggestions/comments are:

Have you raised this matter before?
 Yes No

What would you like to see happen?

(OPTIONAL) My contact details:

Name & Phone Number