Counselling Feedback Form

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Rivers Church

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Sandton
Kyalami
Centurion
Durban North
Ballito

Counselling Feedback Form

Thank you for your feedback, which will help us grow and better meet the needs of our congregation.

Name & Surname
Counsellor*
Date*
Date Format: MM slash DD slash YYYY
Time*

: HH

MM
Did you feel heard and understood?*
- Poor
- Average
- Good
- Excellent
Did your counsellor responded with empathy?*
- Poor
- Average
- Good
- Excellent
Was the advice given grounded in the Word and did it rely on scripture?*
- Poor
- Average
- Good
- Excellent
Did your counsellor treat you with respect?*
- Poor
- Average
- Good
- Excellent
Did your counsellor help you to understand your situation better?*
- Poor
- Average
- Good
- Excellent
Were you given sound and good advice?*
- Poor
- Average
- Good
- Excellent
Has the counselling session helped you to make decisions and solve problems?*
- Poor
- Average
- Good
- Excellent
Did you feel that you were able to trust your counsellor?*
- Poor
- Average
- Good
- Excellent
Did you feel that you could open up and speak honestly about why you were there?*
- Yes
- No
Do you feel that with further sessions you may feel comfortable to share?*
- Yes
- No
Did you feel that the counsellor represented God, the church and its senior leaders well?*
- Poor
- Average
- Good
- Excellent
Were you given homework to do?*
- Yes
- No
Did your counsellor present themselves neatly?*
- Poor
- Average
- Good
- Excellent
Did your counsellor do most of the talking?*
- Yes
- No
Did your counsellor speak too much about themselves?*
- Yes
- No
Were there things that you wanted to tell the counsellor but didn’t feel comfortable?*
- Yes
- No
Were you satisfied with your session?*
- Yes
- No
Would you like to come back for another session with the same counsellor?*
- Yes
- No
Has your situation been resolved?*
- Yes
- No
Please share any other thoughts or comments on your session or counsellor below.
Email
This field is for validation purposes and should be left unchanged.

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