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Private Counselling Feedback Form

Private Counselling Feedback

We would appreciate you taking the time to complete this survey. Feedback helps us to monitor the quality of Rowan services and to make improvements.

Step 1 of 6

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All information you submit is kept according to our privacy policy, access it here.
Please provide the name of your Rowan counsellor*
First Last
Please provide the location of your Rowan counsellor*

Overall, how helpful was the Rowan counsellor you saw?
- Very helpful
- Helpful
- Neither
- Not helpful
- Not at all helpful
How are you feeling now?
- Much better
- Better
- The same
- Worse
- Much worse
How much did the Rowan counsellor/therapist help with your personal life?
- A great deal
- Quite a bit
- A little
- Not very much
- Not at all
- Not applicable
How much did the Rowan counsellor/therapist help with your work life?
- A great deal
- Quite a bit
- A little
- Not very much
- Not at all
- Not applicable

Please rate the following aspects of the Rowan counselling/therapy service in their level of importance to you:
Having someone to listen to me
- Very important
- Important
- Unimportant
- Very unimportant
Knowing the counselling/therapy was confidential
- Very important
- Important
- Unimportant
- Very unimportant
Getting a different perspective on my situation
- Very important
- Important
- Unimportant
- Very unimportant
Talking to someone independent and impartial
- Very important
- Important
- Unimportant
- Very unimportant
Building a relationship with the counsellor/therapist
- Very important
- Important
- Unimportant
- Very unimportant
Receiving information and/or guidance
- Very important
- Important
- Unimportant
- Very unimportant

Please rate how you feel about practical aspects of the Rowan counselling/therapy service using the scale below.
The way you were dealt with when you first contacted us
- Very satisfied
- Satisfied
- Unsatisfied
- Very unsatisfied
The time you had to wait until your first appointment
- Very satisfied
- Satisfied
- Unsatisfied
- Very unsatisfied
The gaps between appointments
- Very satisfied
- Satisfied
- Unsatisfied
- Very unsatisfied
The surroundings you were seen in
- Very satisfied
- Satisfied
- Unsatisfied
- Very unsatisfied
The counselling style of the counsellor/therapist you saw
- Very satisfied
- Satisfied
- Unsatisfied
- Very unsatisfied

Would you see a counsellor again?
- Yes
- No
- Maybe
Would you recommend the service to a colleague?
- Yes
- No
- Maybe
Do you have any other comments you would like to make about the service?

Use for publicity?
- I agree to my anonymous comments being used for publicity purposes.
We ask for your consent to use your comments for publicity purposes. All information identifying you will be removed.
Would you like us to contact you about your feedback?
- Yes
- No
Name*
First Last
Email*
Phone
Thank you for your feedback. If you would like to stay in touch with Rowan, sign up for our newsletter here.

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