Counseling Evaluation Form

Counselor Name: ______________________

Site: _________________

Approximate # of sessions with Counselor: __________

Scaling: 1 (disagree) – 7 (agree)

Part 1: Evaluating the Site
1. The space was easy to get to 1 2 3 4 5 6 7 N/A
2. The space was comfortable 1 2 3 4 5 6 7 N/A
3. I was able to leave messages for my 1 2 3 4 5 6 7 N/A
counselor when I needed to

Part 2: Evaluating your Counselor

1. Available to meet regularly 1 2 3 4 5 6 7 N/A
2. Accepting of me as a person 1 2 3 4 5 6 7 N/A
3. Knowledgeable 1 2 3 4 5 6 7 N/A
4. Understanding of me 1 2 3 4 5 6 7 N/A
5. Helped me toward my goals 1 2 3 4 5 6 7 N/A
6. Pushed me to discover solutions 1 2 3 4 5 6 7 N/A
7. Provided direction in our session 1 2 3 4 5 6 7 N/A
8. Spoke in an understanding way 1 2 3 4 5 6 7 N/A
9. Appeared authentic 1 2 3 4 5 6 7 N/A
10. Listened intently/Reflected they were listening 1 2 3 4 5 6 7 N/A
11. Encouraged me to do most of the talking 1 2 3 4 5 6 7 N/A
12. Behaved professionally 1 2 3 4 5 6 7 N/A
13. Was open and honest 1 2 3 4 5 6 7 N/A
14. Asked what my goals were for counseling 1 2 3 4 5 6 7 N/A
15. Encouraged me to set goals 1 2 3 4 5 6 7 N/A
16. Suggested new/different ways to achieve my goals 1 2 3 4 5 6 7 N/A
17. Helped me achieve my goals in counseling 1 2 3 4 5 6 7 N/A
18. Supported my attempts to change 1 2 3 4 5 6 7 N/A
19. Was flexible 1 2 3 4 5 6 7 N/A
20. Suggested new ways to think, feel, or behave 1 2 3 4 5 6 7 N/A
21. Used techniques to help me solve my problems 1 2 3 4 5 6 7 N/A
22. Assigned tasks for me to complete 1 2 3 4 5 6 7 N/A
23. Trusted to keep confidentiality 1 2 3 4 5 6 7 N/A
24. Summarized what occurred in our session 1 2 3 4 5 6 7 N/A
25. I would recommend my counselor to others 1 2 3 4 5 6 7 N/A

Part 3: Evaluating your experience as a Client

1. I consider counseling to be helpful to me 1 2 3 4 5 6 7 N/A
2. I would recommend this site to others 1 2 3 4 5 6 7 N/A
 3. I would enter counseling again 1 2 3 4 5 6 7 N/A
4. I felt comfortable meeting with my counselor 1 2 3 4 5 6 7 N/A
5. After sessions I tended to feel hopeful 1 2 3 4 5 6 7 N/A
6. I felt satisfied with how the counseling relationship ended 1 2 3 4 5 6 7 N/A

What I liked best about counseling was:

What I would like to see changed: