Post-Session Survey

This survey is meant to be completed after each session. As with all client information, your responses will be kept strictly confidential. We will need some type of identifier to match your responses with your case that we have on file. This identifier could be your case ID number (you'll find it on your invoice) or the time of your last session, or you could use the first three letters of your last name and first initial (include middle initial if your spouse has same first initial as you), or some other identifier you have pre-arranged with your therapist.

You are also free to complete this survey by hardcopy if you prefer. If you choose the hardcopy option instead, you can fax your completed survey to us at (403) 255-8570 (confidential fax) or bring it with you to your next session.

Please refer to the privacy policy for Cobb & Associates Inc. if you have any questions about privacy and your personal information.

This survey should take about 2-3 minutes to complete. Not every field has to be filled out, but you will need to finish what you intend to submit in one sitting as you cannot save a partially completed form and come back to it later to continue working on it. If you want to keep a copy for your own records, please print this page on your browser before you submit the survey.

Please note that all fields followed by an asterisk must be filled in.
(This could be a Case ID number as it appears on a recent invoice, or the time of your last session as in 1300, or the first three letters of your last name and first initial).*
(If you are coming with your spouse, this helps us to identify you further, but it is not required)
Male
Female
Nathan Cobb
Russ Millington
Diane Gibson
Erla Christens
Shezlina Haji

a. Think of the problems or issues you wanted to resolve when you first came to counselling. Select a number below that best reflects how much improvement you feel you have made in resolving those concerns, thus far.

0.0 We Have Only Had 1 or 2 Sessions, Too Early to Tell
0.0 No Improvement
0.5
1.0 Some Improvement
1.5
2.0 Moderate Improvement
2.5
3.0 Much Improvement
3.5
4.0 Mostly Resolved
4.5
5.0 Resolved
0.0 No Improvement
0.5
1.0 Some Improvement
1.5
2.0 Moderate Improvement
2.5
3.0 Much Improvement
3.5
4.0 Mostly Resolved
4.5
5.0 Resolved

(i.e. In terms of feeling heard and understood, creating a plan, fostering hope, understanding the issues better, being able to talk things out, getting unstuck, etc..)
*

1 Not Helpful
2
3
4
5
6
7
8
9
10 Very Helpful

(i.e. Were there topics you wanted to discuss but didn't, things you would like to change about the counselling process, approaches that might work better for you? etc..)

Note: This could be a positive shift in your emotions, perspective, behavior, or attitude that creates hope, new possibilities or leads to solutions. Examples include seeing a new perspective, learning something new about yourself, seeing your partner in a different way, letting go of hard feelings, or developing a skill that helps you to accomplish your goals.

"I am starting to have clear ideas about what I need to focus on to resolve the issues that prompted me to seek counselling."*

Yes
Not Sure
No

(Be sure to print this page out or write these steps down somewhere before you hit the submit button so you can refer to them later.)