Essential Families

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

Provider ID
Client ID

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 Home…
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
I actively participate in individual activities?
I felt respected by my counselor?
I show respect and am respectful to my counselor?
I show respect and am respectful towards my peers?
My counselor listened to my problems?

	1Strongly Disagree	2Somewhat Disagree	3No Strong Feeling	4Somewhat Agree	5Strongly Agree
Individual counseling helped me find solutions to my problems and concerns?
Counseling helped me deal with problems at home, school, or work?
Individual counseling helped me get along better with my family, teachers, or co-workers?
Individual counseling helped me get along better with my family, classmates, or co-workers?
I am better able to cope when things go wrong?

	1Strongly Disagree	2Somewhat Disagree	3No Strong Feeling	4Somewhat Agree	5Strongly Agree
Counseling has helped me to solve problems without violence/fights?
Counseling has helped me learn better ways of expressing and communicate my feelings:
I am happy with the help I received in counseling?

Client Session Assessment Mental Wellness

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