Form Center

2. FCSS Counselling Evaluation, Client Survey - Sessions 1 & 4 Follow-up
4. 
5. 
7. THANK YOU FOR TAKING A MOMENT TO COMPLETE THIS SURVEY!
   Your answers help continue and improve the partnership between FCSS (Family and Community Support Services) and Nexus Psychology. Without this program, some families in the County of Wetaskiwin may not be able to access affordable counselling. Please answer all questions honestly and if you have nay questions or conerns, please contact 780-352-3321 ext. 2292 or fcss@county10.ca. All answers are confidential.
9. First Name
10. Last Name
12. Email Address (Optional)
13. Telephone (Optional)
17. I was spoken to and greeted in a friendly manner while booking my first appointment?

    1. Strongly Agree
    2. Agree
    3. Undecided
    4. Disagree
    5. Strongly Disagree
18. Forms and paperwork were clear and easy to understand:

    1. Strongly Agree
    2. Agree
    3. Undecided
    4. Disagree
    5. Strongly Disagree
19. Payment options were explained to me clearly:

    1. Strongly Agree
    2. Agree
    3. Undecided
    4. Disagree
    5. Strongly Disagree
21. My counsellor spoke to me in friendly manner:

    1. Always
    2. Very Frequently
    3. Occassionally
    4. Rarely
    5. Very Rarely
    6. Never
22. My counsellor introduced themselves on my first visit:

    1. Yes
    2. No
23. I my wait times before an appointment were:

    1. 0-15 minutes
    2. 15-30 minutes
    3. 30-60 minutes
    4. 60 + minutes
25. My counsellor is supportive without be judgemental:

    1. Always
    2. Very Frequently
    3. Occasionally
    4. Rarely
    5. Very Rarely
    6. Never
26. As a result of counselling, I feel more confident about myself:

    1. Strongly Agree
    2. Agree
    3. Undecided
    4. Disagree
    5. Strongly Disagree
27. As a result of counselling, i have a greater confidence in my ability to overcome life's challenges:

    1. Strongly Agree
    2. Agree
    3. Undecided
    4. Disagree
    5. Strongly Disagree
29. I feel I new information on how to better manage my stress:

    1. Strongly Agree
    2. Agree
    3. Undecided
    4. Disagree
    5. Strongly Disagree
30. I feel I am better at expressing my emotions constructively:

    1. Strongly Agree
    2. Agree
    3. Undecided
    4. Disagree
    5. Strongly Disagree
31. I feel better about my ability to solve problems:

    1. Strongly Agree
    2. Agree
    3. Undecided
    4. Disagree
    5. Strongly Disagree
33. Name of Counsellor
    -- Select One --I don't rememberFrancess Tassone
34. I would recommend Nexus Psychology to a friend:
    -- Select One --AgreeUndecidedDisagree
36. We appreciate your comments and feedback:
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit Submit and Print

* indicates a required field