Client Session Assessment Mental Wellness

On a scale from 1 to 5, 1 beind the lowest and 5 being the highest, how are you feeling today?

1 Rage, Furious 2 Angry, Mad 3 Frustured, Confused, Annoyed, Sad 4 Nervous, Worried, Anxious 5 Happy, Calm, Satisfied, Pleased, Okay

Counselling is what you make of it! It is up to you to use the tools, and techniques that are shared with you to better serve your community, city, and state. As we believe, EveryThing starts at Homeā€¦
This form allows you an opportunity to provide feedback to your provider after your session is complete.
Please place a mark in the box which is most closely corresponds to how you feel about each statement.

1-Strongly Disagree, 2-Somewhat Disagree, 3-No Strong Feeling, 4-Somewhat Agree, 5-Strongly Agree.



1Strongly Disagree 2Somewhat Disagree 3No Strong Feeling 4Somewhat Agree 5Strongly Agree
1Strongly Disagree 2Somewhat Disagree 3No Strong Feeling 4Somewhat Agree 5Strongly Agree
1Strongly Disagree 2Somewhat Disagree 3No Strong Feeling 4Somewhat Agree 5Strongly Agree