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Counselling Service Evaluation Form (Parents/Carers)

About your child

They received bereavement counselling

They received counselling because a family member has a life limiting illness

Initial Contact and/or First Visit

Some children are referred for support by other agencies/workers. Sometimes family members make the first contact themselves.

How happy were you with the speed of response following the referral of your child to this service?(Required)

Please choose from the drop down options where 1 = very unhappy and 5 = very happy

How would you rate the first visit in terms of your child's experience?(Required)

Please choose from the drop down options where 1 = very negative and 5 = very positive

How clearly were issues relating to confidentiality explained?(Required)

Please choose from the drop down options where 1 = very unclearly and 5 = very clearly

Support Sessions

How would you rate your level of concern about your child BEFORE they started receiving support?(Required)

Please choose from the drop down options where 1 = very low and 5 = very high

How would you rate your level of concern about your child AT THE END of your child's support sessions?(Required)

Please choose from the drop down options where 1 = very low and 5 = very high

To what extent do you feel the support sessions addressed the needs of your child in relation to their difficulties?(Required)

Please choose from the drop down options where 1 = very little and 5 = very much

How do you think your child feels about the support they received? (Note: children receive a seperate questionnaire but it's helpful to have your view on this as well)(Required)

Please choose from the drop down options where 1 = very unhappy and 5 = very happy

What did you think about the support worker providing the support?(Required)

Please choose from the drop down options where 1 = very unhappy and 5 = very happy

After the support ended

How do you feel about the number of sessions provided and length of time the support was available?(Required)

Please choose from the drop down options where 1 = very unhappy and 5 = very happy

Do you think you would make use of this service again should the need arise with your child?(Required)

Would you recommend this service to other people?(Required)

Please use this space for anything else you'd like to say

Your details (optional)

This form is anonymous however if you are happy to share your feedback further, please complete the sections below.

In the unfortunate event that you have any concerns about the service you received, would you like the Counselling Services Manager to contact you?

Are you happy for us to share your feedback with your child's counsellor/support worker?

Are you happy for us to share your comments anonymously in publicity?

Would you be happy to share your feedback more widely - to help us promote our services in the local press or through social media?

Name (optional)

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Phone (optional)

Email (optional)

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Your feedback counts

Please contact us for care and support

Counselling Service Evaluation Form (Parents/Carers)

Initial Contact and/or First Visit

Support Sessions

After the support ended

Your details (optional)

Related News

Daughter to walk in memory of dad

Hospice Leads Groundbreaking Research into Forest Bathing for Palliative Care

Treetops Hospice Open New Store in Belper

Our Care

Wellbeing Space

Hospice at Home

Therapeutic Services

Wellbeing at Home

Support and Information

For professionals

Care home support

Befriending Service

Compassionate Communities Project

Ask about our services