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Client-Counselor Feedback
We appreciate you taking the time to provide feedback on your experience here at Insight. Telling us about your experience will help to improve your counselor’s professional development as well as the services we offer to you, your family and others. You do not have to identify yourself but we would appreciate it if you would consider doing so in order that we may follow-up with you if we have questions or to notify you of changes we have made based upon your feedback. Your identity will not be revealed to your counselor, the President of The Insight Program, will review these forms directly. Please place a mark in the box which most closely corresponds to how you feel about each statement.
YOUR CONTACT INFORMATION
By providing this information, you are consenting to follow-up contact from The Insight Program.
Name
First
Last
Phone
ABOUT THE WORKING RELATIONSHIP WITH YOUR COUNSELOR
My counselor listened to me effectively.
Strongly Agree
Somewhat Agree
No Strong Feeling
Somewhat Disagree
Strongly Disagree
My counselor understood things from my point of view.
Strongly Agree
Somewhat Agree
No Strong Feeling
Somewhat Disagree
Strongly Disagree
My counselor focused on what was important to me.
Strongly Agree
Somewhat Agree
No Strong Feeling
Somewhat Disagree
Strongly Disagree
My counselor accepted what I had to say without judging me.
Strongly Agree
Somewhat Agree
No Strong Feeling
Somewhat Disagree
Strongly Disagree
My counselor showed warmth to me.
Strongly Agree
Somewhat Agree
No Strong Feeling
Somewhat Disagree
Strongly Disagree
My counselor fostered a safe & trusting environment.
Strongly Agree
Somewhat Agree
No Strong Feeling
Somewhat Disagree
Strongly Disagree
My counselor began and ended our session(s) on time.
Strongly Agree
Somewhat Agree
No Strong Feeling
Somewhat Disagree
Strongly Disagree
My counselor followed my lead during our sessions whenever that was appropriate.
Strongly Agree
Somewhat Agree
No Strong Feeling
Somewhat Disagree
Strongly Disagree
I was able to schedule appointments at times convenient to my schedule.
Strongly Agree
Somewhat Agree
No Strong Feeling
Somewhat Disagree
Strongly Disagree
ABOUT THE RESULTS OF WORKING WITH YOUR COUNSELOR
The sessions with my counselor helped me with the reason I originally came to counseling.
Strongly Agree
Somewhat Agree
No Strong Feeling
Somewhat Disagree
Strongly Disagree
My counselor and I were able to work together to develop strategies to improve the areas of my life that concern me.
Strongly Agree
Somewhat Agree
No Strong Feeling
Somewhat Disagree
Strongly Disagree
OVERALL SATISFACTION
My overall level of satisfaction with the services provided to me by Insight is:
Very Satisfied
Somewhat Satisfied
No Strong Feeling
Somewhat Dissatisfied
Strongly Dissatisfied
Based on my experience at Insight, I would recommend the services to others:
Very Satisfied
Somewhat Satisfied
No Strong Feeling
Somewhat Dissatisfied
Strongly Dissatisfied
Additional Comments:
Please select the name of the counselor you worked with:
Johna Stephens
Jennifer Engelhaupt
Cathy McCawley
Other
If you selected Other for Counselor you worked with please indicate the name of who you worked with below.
