Intake Form

Program Delivery Feedback Form

As part of our ongoing commitment to provide the highest quality mental health services, we would greatly appreciate your feedback on your recent experience with us.

Your feedback is confidential and will go directly to the Executive Director. Your feedback will be used solely for the purpose of improving our services. If you have any urgent concerns or require immediate assistance, please do not hesitate to contact us directly at 250-344-2000.

Your insights are invaluable in helping us understand what we are doing well and where we can make improvements. Please take a few minutes to complete the following feedback form:

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Name(Required)
How would you rate your overall experience?(Required)
How would you rate your counselors ability to listen and understand your concerns?(Required)
Did you feel safe and respected during the sessions?(Required)
How comfortable did you feel with the counselor?(Required)
How effective were the sessions in addressing your concerns?(Required)
Did you feel the sessions provided useful strategies or insights?(Required)
Did the counselor explain things in a way you could understand?(Required)
How would you rate the comfort and privacy of the counseling environment?(Required)
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