Counselling Evaluation Thank you for taking a few minutes to complete the following evaluation form. Your feedback will help us get a better understanding of whether counselling is helpful and if so why Please note the form is better viewed on a tablet or PC/Laptop rather than a Mobile device. Counselling Evaluation Form Thank you for taking the time to complete our evaluation form for your recent counselling sessions.It is very important that you enter the unique Therapy evaluation ID we sent you via email in the field below, to help us log your form correctly. Therapy evaluation ID Please use the unique Therapy ID sent to you in our email. Please use the format "T-000001" Details for person who received counselling First Name Last Name Phone Whichever is your preferred number Email Counselling details Date of first session Date of final session Name of counsellor Question 1 Please score the following statements based on how you feel now. Your understanding of the impact meningitis has had on youN/A1 (poor)2 (fair)3 (good)4 (very good)5 (excellent) Your ability to cope with the impact of meningitisN/A1 (poor)2 (fair)3 (good)4 (very good)5 (excellent) Your ability to overcome some of the physical after-effects of meningitisN/A1 (poor)2 (fair)3 (good)4 (very good)5 (excellent) Your relationship with othersN/A1 (poor)2 (fair)3 (good)4 (very good)5 (excellent) Your feelings of general wellbeingN/A1 (poor)2 (fair)3 (good)4 (very good)5 (excellent) Question 2 Overall, how helpful has this course of counselling been for you?Very helpfulHelpfulSomewhat helpfulNot at all helpful Please tell us why you chose this answer Question 3 What has been the most valuable thing about having counselling? Question 4 Have you achieved what you hoped for from this course of counselling?CompletelyTo a great extentSomewhatNot at all Please tell us why you chose this answer Question 5 Do you think counselling has made a difference in your life? Question 6 Do you feel the counsellor understood your needs? How would you rate the service you received from your counsellor?ExcellentGoodAdequatePoor Are there any further comments you would like to make about your experiences with counselling? Sharing your story From time to time we appreciate being able to share the benefit you have felt from counselling after meningitis. Would you be willing to share your experience, eg case study, evaluation in our publications and on social mediaYes I give permission Need assistance with this form?