Services Evaluation Form | Cross And Crown Coun

Evaluation Form

Thank you for sharing your experience with Cross and Crown Counseling. Your response helps us evaluate and make improvements to our services.

Please note, completing this survey does not indicate a termination of services should you need to return for counseling at a future time or if you are still working with a counselor.

Kate Walpole - Cross and Crown Counseling Clinical Supervisor

NCCA Board Certified Clinical Supervisor, Licensed Clinical Christian Counselor, Advance Certified Temperament Counselor

Counselor

Kate Walpole

Jennika Padilla

Barb Sandberg

Lisa Preston

First name

Last name

On a scale from 1-5, 5 being the best, what would you rate your overall experience at Cross & Crown Counseling?

I felt listened to, heard and supported.

Stongly Agree

Somewhat Agree

Somewhat Disagree

Strongly Disagree

I felt I could express myself without judgement

Stongly Agree

Somewhat Agree

Somewhat Disagree

Strongly Disagree

My counselor fostered a safe and trusting environment.

Stongly Agree

Somewhat Agree

Somewhat Disagree

Strongly Disagree

I was comfortable with my counselors approach.

Stongly Agree

Somewhat Agree

Somewhat Disagree

Strongly Disagree

I felt challenged when appropriate.

Stongly Agree

Somewhat Agree

Somewhat Disagree

Strongly Disagree

We worked on concerns that were most important to me.

Stongly Agree

Somewhat Agree

Somewhat Disagree

Strongly Disagree

What are some of the greatest benefits you've derived from your counseling sessions?

Are there specific negative behaviors or reactions you learned to overcome?

Can you recognize specific areas of improvement or changes in your beliefs and/or responses to life situations?

Did you receive adequate resources and tools to utilize on your own?

Are there any areas that your counselor did not spend enough time on for you?

Is there anything you didn't get from your counselor that you were looking for?

Did the front office team treat you with care, professionalism, and support?

Is there anything more you'd like us to know about your experience here?

Would you recommend our services to others?

Yes

No

Why or why not?