Counselling feedback form

Name and age *

Please use your initials and age only.e.g. Ben Watts age 14 would be BW14

Ethnicity *Please select...Asian or Asian BritishBlack/Black British/Caribbean or AfricanMixed or Multiple ethnic GroupsWhiteOther ethnic group

Your counsellor’s namePlease select...Deborah LinghamTina WalkerTerri FaircloughVictoria DalyBrenda ArmstrongGemma JonesJane JackamanWendy Ambrose

I understood that what I said to the counsellor would be confidential unless my counsellor felt that there was a safeguarding issue

True

Don’t Know

False

I felt safe and heard by my counsellor

True

Don’t Know

False

I feel more able to deal with the challenges in my life since having counselling

True

Don’t Know

False

I would recommend Elliott Holmes Memorial Fund (EHMF) to others

True

Don’t Know

False

Is there anything you feel we can do to improve our service?

Please use this section for additional comments or a testimonial to encourage other young people to get help *

We may use as a testimonial to encourage others to seek help. This may be used to encourage other to seek help. This will be kept anonymous.

Thank you for taking the time to complete this questionnaire. Your answers will help develop and improve our service. Your feedback will be kept confidential.