Date *
Date
Answer the Following *
Answer the Following
My first contact with Waterloo was positive.
I felt Waterloo responded to my need in a timely manner.
Appointment and scheduling procedures were clearly communicated.
I felt comfortable with Waterloo's environment (i.e. rooms, furniture, temperature, noise level).
My counselor listened and understood the concerns I brought to counseling.
My counselor helped me to clarify the nature of my concerns.
My counselor helped me develop better ways of coping with the problems, feelings or situation that brought me to Waterloo.
I felt that my counselor respected me as a person.
I trust that my counselor will maintain my confidentiality.
My counselor seemed genuinely interested in helping me.
I would refer friends to Waterloo.
I would recommend my counselor to others.
I would return for counseling if I felt the need.
I am better prepared now to work through future challenges.
My experience at Waterloo has positively affected my life.
Overall, my counseling was effective.
Name (optional)
Name (optional)
Therapist's Name
Therapist's Name
May we use your comments (without your name or any identifying information) in our printed materials and website? *