Please enter your client number

1. How many sessions of counselling did you receive?

2. Did you feel your counsellor understood your issues?

3. Did counselling enable you to view your problem differently?

4. Overall, how helpful did you find your sessions?

5. Would you use this form of counselling again?

Remembering your answers before counselling, highlight the number which corresponds with how you now feel

1. I have difficulty saying, "No"

2. I have difficulty asserting myself

3. I am not very good at maintaining boundaries

4. I don’t get much “me” time

5. I feel stressed a lot of the time currently

6. I do not have a good work life balance

7. I enjoy caring for others

8. I dislike conflict

9. I have good self-esteem

10. If things go wrong I usually blame myself

11. I dislike change

12. I like to be the one who sorts things out