NWCASA/CARE Center Counseling Services Evaluation
Client input is essential for ensuring that services meet the needs of sexual assault/abuse victims and their friends and loved ones. Please complete this evaluation to summarize center services received.
* Required
Date:
*
MM
/
DD
/
YYYY
Please check all that apply:
*
Client age 12 and over
Parent of a client under 12
Victim
Significant Other
Required
What is your counselor's name?
*
Your answer
Months receiving services:
*
0-3
3-6
6-12
12-18
18-24
24 or more
Counseling has helped me feel better about myself.
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Strongly Disagree
1
2
3
4
5
Strongly Agree
I have learned healthy ways to cope.
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Strongly Disagree
1
2
3
4
5
Strongly Agree
I feel less fear and/or anxiety than when I started counseling.
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Strongly Disagree
1
2
3
4
5
Strongly Agree
I feel supported by my therapist in my counseling.
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Strongly Disagree
1
2
3
4
5
Strongly Agree
My life has improved.
*
Strongly Disagree
1
2
3
4
5
Strongly Agree
I have a better understanding of the choices and resources available to me.
*
Strongly Disagree
1
2
3
4
5
Strongly Agree
My therapist respects my diversity as a person (ie. racial, cultural, religious, sexual identity).
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Strongly Disagree
1
2
3
4
5
Strongly Agree
I would recommend NWCASA/CARE Center services to a friend or family member.
*
Strongly Disagree
1
2
3
4
5
Strongly Agree
How could NWCASA/CARE Center better provide you services?
Your answer
What have you found to be useful about services at NWCASA/CARE Center?
Your answer
Additional Comments;
Your answer
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