Client Satisfaction Survey

We invite you to complete this questionnaire to evaluate our services. Your responses will be treated in the strictest confidence. Please choose the number that best describes your evaluation of our service.

Effectiveness of our Service

The situation that brought me to counselling has:

My ability to deal with my concerns have:

My personal life has:

My relationship with others has:

My situation at work has : (If applicable)

Quality of our Service

My satisfaction with my counselling is:

My satisfaction with my counsellor(s) ability to make me feel at ease and help me talk about my concern is:

My satisfaction with my counsellor(s) ability to help me is:

Number of sessions received:

The number of sessions was sufficient:

The response time to my request for services was acceptable:

If you were to seek help again, would you come back to our service?

If asked, would you tell others to use our services?

Administration of Service

The reason why you are no longer coming to our service is because:

Personal Information

How did you become aware of our services?

We continually strive to offer our clients quality services and therefore, we would greatly appreciate any other comments / recommendations / concerns you may have with regards to the agency and/or the services being offered:

The Centre gratefully acknowledges funding from the Ministry of Community and Social Services, Ministry of the Attorney General and the North East Local Health Integration Network.

9 Oakland Blvd., Suite 2
Elliot Lake ON | P5A 2T1
Tel/Tél. : 705 848-2585
Fax/Téléc. : 705 848-9687
ccea@vianet.ca