Feedback Form

Service Feedback Form

We highly value your feedback on our service. It helps us understand what we do well, where we can make changes to improve what we do and where we can grow in terms of developing our services. Please think about what your experience of CLEAR has been, from your initial contact, and throughout your counselling/therapy sessions with your counsellor / therapist.

* Denotes required fields. If you have no particular feedback for those fields please enter NA.

To help us prevent spam, please note that only letters, numbers, and common punctuation characters are allowed. Disallowed characters include but are not limited to: @ # / : ;

Please let us know if you were the: *

Client

Parent

Family Member

Partner

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What was really good about your care? *

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Please complete this field, or enter NA if you have no feedback in this area. Only letters, numbers, and certain punctuation characters are allowed.

Was there anything you didn't like or anything that needs improving? *

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Please complete this field, or enter NA if you have no feedback in this area. Only letters, numbers, and certain punctuation characters are allowed.

Is there anything else you want to tell us about the service you received? *

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Please complete this field, or enter NA if you have no feedback in this area. Only letters, numbers, and certain punctuation characters are allowed.

Please rate your experience of CLEAR on a scale of 0 - 10, 10 being the best you could have hoped for. *

Please rate your experience of CLEAR

Confirm *

Please tick the box to confirm

Service Feedback Form

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