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Counselling Survey
Name
*
First
Last Name
*
Last
Email
*
Date
Rate Your Experience
1 Star
2 Stars
3 Stars
4 Stars
5 Stars
Overall, how would you rate your experience with us?
How satisfied are you with:
Excellent
Good
OK
Could do better
Very Disappointed
Counsellor
Excellent
Good
OK
Could do better
Very Disappointed
Service
Excellent
Good
OK
Could do better
Very Disappointed
Company Overall
Excellent
Good
OK
Could do better
Very Disappointed
Additional comments or suggestions
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