This survey is meant to be filled out every 3-4 sessions on a periodic basis. Your responses give your therapist immediate feedback about whether counselling is "on the right track" or whether adjustments are needed to make it more helpful to you.
  • PART ONE: Your Perception of Overall Progress

  • PART TWO: Symptom Checklist Follow-up

    Please rate how much you have experienced each symptom over the past week. Note: the first six symptoms relate specifically to your relationship with your spouse or partner – if you are single, use the “0” rating.
  • Part THREE : Client Satisfaction Survey

    please indicate how much you agree or disagree with each statement. These statements have to do with your experience at your counselling sessions. On this scale, 1=strongly disagree and 5=strongly agree.