Counselling Services is continually seeking to improve the quality of service offered to our students, staff and faculty. Since you have visited our Service recently, we would like you to evaluate your experience with us. Your input is very valuable.

This anonymous form will be kept confidential within Counselling Services. The valuable information you provide will be used to improve our Service.

Age:

How did find out about our Service?

Friend

Health Services

Faculty

Staff

Other

Type of Counselling Received:

Individual

Group

Both

Name of Counsellor (most recent):

Cannot Remember Beth Bower Jeanette Gascho Alicia Hendley Brenda Julian Dave Logan Dave Mackay Linda Mackay Kristine Meier Marilyn Perdue Karen Rittinger Tom Ruttan Christine Tauer Martin Wendy Vaughan Kathy Winter Jennifer Yuen Susan Rosenblum Neil Gibson Workshop or Presentation Cassie Smith Anna Wojciechowski

Approximate number of counselling sessions:

1 2 3 4 5 to 10 11+

Reason you came to Counselling (please check all that apply):

Study Skills

Personal Counselling

Career Counselling

University status:

Year 1 Year 2 Year 3 Year 4 Year 5 Graduate Student Faculty Staff Other

In terms of your level of satisfaction,how would you rate the following?
Courtesy of Receptionnist(s)	Excellent Very Good Good Adequate Disappointing
Appointment(s) schedule within satisfactory time	Excellent Very Good Good Adequate Disappointing
Relationship with counsellor	Excellent Very Good Good Adequate Disappointing
Helpfullness of counselling	Excellent Very Good Good Adequate Disappointing
I would recommend Counselling Services to a friend	Yes Maybe No

How important has counselling been in improving or maintaining your academic performance at the University of Waterloo?

Very Important Moderately Important Not Important not applicable

How important has your contact with our Service been in any decision to continue your education at the University of Waterloo?

Very Important Moderately Important Not Important not applicable

Please comment on how your counselling experience was or was not helpful to you.

Any further comments or suggestions?

Would you consent to the sharing of your comments for administrative purposes?

Yes

No

Counselling Services
Needles Hall Room 2080
University of Waterloo
200 University Avenue West
Waterloo, Ontario, Canada N2L 3G1
519 888 4567 x32655 Fax # 519-888-4366

Contact Office | Give us feedback on our website | Counselling Services home page