Evaluation Form

 

We appreciate your comments and feedback so that we can continuously improve services.

 

 

I was referred by:

               

 

Directions:
Please select the answer to questions 1-9 by indicating whether you agree or disagree with each statement according to the following:

   
Strongly
Agree
(4)
Agree Mostly
(3)
Disagree Mostly
(2)
Strongly Disagree
(1)
   
Not Applicable

1.  The clerical staff provided professional and courteous assistance by phone or in person.

   

2.  My counselor reviewed information regarding confidentiality.

   

3.  My counselor understood my concerns and provided useful information or assistance.

   

4.  I would return to Counseling Services if I believed I needed assistance or information again.

   

5.  As a result of counseling I will be able to achieve the goals important to me.

   

6.  As a result of counseling I will be able to express my thoughts and feelings more effectively.

   

7.  As a result of counseling I will be able to effectively complete my college education.

   

8. As a result of counseling I have taken steps to make healthy and more balanced choices regarding my emotional, intellectual, physical and spiritual health.

   

9. As a result of counseling I have an improved self-concept.

   

10. As a result of counseling I am better able to manage my emotions.

   

11. As a result of counseling I am better able to cope with psychologically distressful situations.

   

 

 

Last Revised: 9/08

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