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Name *

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Last

Email *

Please select the counselor you've seen. *

Please share how many sessions you've had. *

0 - 4
5 - 10
More than 10


0	1	2	3	4	5	6	7	8	9	10

What has been most helpful about your time with your counselor? *

What has been least helpful about your time with your counselor? *

What might your counselor improve upon? *

What did your counselor do well? *

What else would you like us to know about your experience at Gospel Care Collective that would help us to make it more comfortable and /or helpful for you or others? *

How would you describe your experience with your counselor at Gospel Care Collective?? *

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
My counselor was helpful and caring in providing information and booking my first session.	Strongly DisagreeMy counselor was helpful and caring in providing information and booking my first session. Strongly Disagree	DisagreeMy counselor was helpful and caring in providing information and booking my first session. Disagree	NeutralMy counselor was helpful and caring in providing information and booking my first session. Neutral	AgreeMy counselor was helpful and caring in providing information and booking my first session. Agree	Strongly AgreeMy counselor was helpful and caring in providing information and booking my first session. Strongly Agree
My counselor listens to me effectively and intentionally.	Strongly DisagreeMy counselor listens to me effectively and intentionally. Strongly Disagree	DisagreeMy counselor listens to me effectively and intentionally. Disagree	NeutralMy counselor listens to me effectively and intentionally. Neutral	AgreeMy counselor listens to me effectively and intentionally. Agree	Strongly AgreeMy counselor listens to me effectively and intentionally. Strongly Agree
My counselor demonstrates to me that they understand things from my own point of view.	Strongly DisagreeMy counselor demonstrates to me that they understand things from my own point of view. Strongly Disagree	DisagreeMy counselor demonstrates to me that they understand things from my own point of view. Disagree	NeutralMy counselor demonstrates to me that they understand things from my own point of view. Neutral	AgreeMy counselor demonstrates to me that they understand things from my own point of view. Agree	Strongly AgreeMy counselor demonstrates to me that they understand things from my own point of view. Strongly Agree
My counselor demonstrates to me that they understand things from a Biblical perspective and invites me to consider it.	Strongly DisagreeMy counselor demonstrates to me that they understand things from a Biblical perspective and invites me to consider it. Strongly Disagree	DisagreeMy counselor demonstrates to me that they understand things from a Biblical perspective and invites me to consider it. Disagree	NeutralMy counselor demonstrates to me that they understand things from a Biblical perspective and invites me to consider it. Neutral	AgreeMy counselor demonstrates to me that they understand things from a Biblical perspective and invites me to consider it. Agree	Strongly AgreeMy counselor demonstrates to me that they understand things from a Biblical perspective and invites me to consider it. Strongly Agree
My counselor has helped me identify my goals.	Strongly DisagreeMy counselor has helped me identify my goals. Strongly Disagree	DisagreeMy counselor has helped me identify my goals. Disagree	NeutralMy counselor has helped me identify my goals. Neutral	AgreeMy counselor has helped me identify my goals. Agree	Strongly AgreeMy counselor has helped me identify my goals. Strongly Agree
My counselor focuses our sessions around my goals.	Strongly DisagreeMy counselor focuses our sessions around my goals. Strongly Disagree	DisagreeMy counselor focuses our sessions around my goals. Disagree	NeutralMy counselor focuses our sessions around my goals. Neutral	AgreeMy counselor focuses our sessions around my goals. Agree	Strongly AgreeMy counselor focuses our sessions around my goals. Strongly Agree
My counselor centers our sessions around Scripture and utilizes it in counseling.	Strongly DisagreeMy counselor centers our sessions around Scripture and utilizes it in counseling. Strongly Disagree	DisagreeMy counselor centers our sessions around Scripture and utilizes it in counseling. Disagree	NeutralMy counselor centers our sessions around Scripture and utilizes it in counseling. Neutral	AgreeMy counselor centers our sessions around Scripture and utilizes it in counseling. Agree	Strongly AgreeMy counselor centers our sessions around Scripture and utilizes it in counseling. Strongly Agree
My counselor prays with/for me in our session.	Strongly DisagreeMy counselor prays with/for me in our session. Strongly Disagree	DisagreeMy counselor prays with/for me in our session. Disagree	NeutralMy counselor prays with/for me in our session. Neutral	AgreeMy counselor prays with/for me in our session. Agree	Strongly AgreeMy counselor prays with/for me in our session. Strongly Agree
My counselor consistently listens to what I am saying without judgment.	Strongly DisagreeMy counselor consistently listens to what I am saying without judgment. Strongly Disagree	DisagreeMy counselor consistently listens to what I am saying without judgment. Disagree	NeutralMy counselor consistently listens to what I am saying without judgment. Neutral	AgreeMy counselor consistently listens to what I am saying without judgment. Agree	Strongly AgreeMy counselor consistently listens to what I am saying without judgment. Strongly Agree
My counselor consistently shows warmth, patience, and kindness toward me.	Strongly DisagreeMy counselor consistently shows warmth, patience, and kindness toward me. Strongly Disagree	DisagreeMy counselor consistently shows warmth, patience, and kindness toward me. Disagree	NeutralMy counselor consistently shows warmth, patience, and kindness toward me. Neutral	AgreeMy counselor consistently shows warmth, patience, and kindness toward me. Agree	Strongly AgreeMy counselor consistently shows warmth, patience, and kindness toward me. Strongly Agree
My counselor fosters a safe and trusting environment.	Strongly DisagreeMy counselor fosters a safe and trusting environment. Strongly Disagree	DisagreeMy counselor fosters a safe and trusting environment. Disagree	NeutralMy counselor fosters a safe and trusting environment. Neutral	AgreeMy counselor fosters a safe and trusting environment. Agree	Strongly AgreeMy counselor fosters a safe and trusting environment. Strongly Agree
My counselor demonstrates humility.	Strongly DisagreeMy counselor demonstrates humility. Strongly Disagree	DisagreeMy counselor demonstrates humility. Disagree	NeutralMy counselor demonstrates humility. Neutral	AgreeMy counselor demonstrates humility. Agree	Strongly AgreeMy counselor demonstrates humility. Strongly Agree
My counselor begins and finishes all our session on time.	Strongly DisagreeMy counselor begins and finishes all our session on time. Strongly Disagree	DisagreeMy counselor begins and finishes all our session on time. Disagree	NeutralMy counselor begins and finishes all our session on time. Neutral	AgreeMy counselor begins and finishes all our session on time. Agree	Strongly AgreeMy counselor begins and finishes all our session on time. Strongly Agree
My counselor is able to follow my lead during our sessions whenever it is appropriate.	Strongly DisagreeMy counselor is able to follow my lead during our sessions whenever it is appropriate. Strongly Disagree	DisagreeMy counselor is able to follow my lead during our sessions whenever it is appropriate. Disagree	NeutralMy counselor is able to follow my lead during our sessions whenever it is appropriate. Neutral	AgreeMy counselor is able to follow my lead during our sessions whenever it is appropriate. Agree	Strongly AgreeMy counselor is able to follow my lead during our sessions whenever it is appropriate. Strongly Agree
My counselor provides practical guidance throughout our sessions when or if it is appropriate.	Strongly DisagreeMy counselor provides practical guidance throughout our sessions when or if it is appropriate. Strongly Disagree	DisagreeMy counselor provides practical guidance throughout our sessions when or if it is appropriate. Disagree	NeutralMy counselor provides practical guidance throughout our sessions when or if it is appropriate. Neutral	AgreeMy counselor provides practical guidance throughout our sessions when or if it is appropriate. Agree	Strongly AgreeMy counselor provides practical guidance throughout our sessions when or if it is appropriate. Strongly Agree
My counselor provides biblical instruction and insight whenever appropriate.	Strongly DisagreeMy counselor provides biblical instruction and insight whenever appropriate. Strongly Disagree	DisagreeMy counselor provides biblical instruction and insight whenever appropriate. Disagree	NeutralMy counselor provides biblical instruction and insight whenever appropriate. Neutral	AgreeMy counselor provides biblical instruction and insight whenever appropriate. Agree	Strongly AgreeMy counselor provides biblical instruction and insight whenever appropriate. Strongly Agree
My counselor challenges me whenever it is appropriate.	Strongly DisagreeMy counselor challenges me whenever it is appropriate. Strongly Disagree	DisagreeMy counselor challenges me whenever it is appropriate. Disagree	NeutralMy counselor challenges me whenever it is appropriate. Neutral	AgreeMy counselor challenges me whenever it is appropriate. Agree	Strongly AgreeMy counselor challenges me whenever it is appropriate. Strongly Agree
My counselor provides optional homework whenever it is appropriate.	Strongly DisagreeMy counselor provides optional homework whenever it is appropriate. Strongly Disagree	DisagreeMy counselor provides optional homework whenever it is appropriate. Disagree	NeutralMy counselor provides optional homework whenever it is appropriate. Neutral	AgreeMy counselor provides optional homework whenever it is appropriate. Agree	Strongly AgreeMy counselor provides optional homework whenever it is appropriate. Strongly Agree
My counselor’s approach has been a good fit for me so far	Strongly DisagreeMy counselor’s approach has been a good fit for me so far Strongly Disagree	DisagreeMy counselor’s approach has been a good fit for me so far Disagree	NeutralMy counselor’s approach has been a good fit for me so far Neutral	AgreeMy counselor’s approach has been a good fit for me so far Agree	Strongly AgreeMy counselor’s approach has been a good fit for me so far Strongly Agree
My counselor has helped me reach my goals	Strongly DisagreeMy counselor has helped me reach my goals Strongly Disagree	DisagreeMy counselor has helped me reach my goals Disagree	NeutralMy counselor has helped me reach my goals Neutral	AgreeMy counselor has helped me reach my goals Agree	Strongly AgreeMy counselor has helped me reach my goals Strongly Agree

Please provide a short testimony of your experience with your counselor. This may be shared on our website, but will not use your full name.

Can our Director contact you to follow up on any concerns you have expressed on this form?

If you have not returned to counseling, please let us know why:

I haven’t reached my goals and completed my therapy yet
My counselor is full
I can’t afford it
It is not a good time for me to continue
My counselor was not a good fit for me

Our counsellors are ready to meet with you!