Please enable JavaScript in your browser to complete this form.Your response to this evaluation form is extremely important to us. We are interested in your honest opinions, whether they are positive or negative. Your comments and suggestions assist us in monitoring and in improving our services. We thank you in advance for your help. The information provided is confidential. For each statement below, please indicate how much you agree or disagree. Please circle the number representing your feelings about that statement.As a result of my counseling at Anchorpoint I have experienced improvements in my.... * (1) Strongly Disagree(2) Disagree(3) Neutral(4) Agree(5) Strongly Agree Symptoms (presenting problems)(1) Strongly DisagreeSymptoms (presenting problems) (1) Strongly Disagree(2) DisagreeSymptoms (presenting problems) (2) Disagree(3) NeutralSymptoms (presenting problems) (3) Neutral(4) AgreeSymptoms (presenting problems) (4) Agree(5) Strongly AgreeSymptoms (presenting problems) (5) Strongly AgreeAttitude(1) Strongly DisagreeAttitude (1) Strongly Disagree(2) DisagreeAttitude (2) Disagree(3) NeutralAttitude (3) Neutral(4) AgreeAttitude (4) Agree(5) Strongly AgreeAttitude (5) Strongly AgreeSelf-Control(1) Strongly DisagreeSelf-Control (1) Strongly Disagree(2) DisagreeSelf-Control (2) Disagree(3) NeutralSelf-Control (3) Neutral(4) AgreeSelf-Control (4) Agree(5) Strongly AgreeSelf-Control (5) Strongly AgreeCoping Skills(1) Strongly DisagreeCoping Skills (1) Strongly Disagree(2) DisagreeCoping Skills (2) Disagree(3) NeutralCoping Skills (3) Neutral(4) AgreeCoping Skills (4) Agree(5) Strongly AgreeCoping Skills (5) Strongly AgreeRelationships(1) Strongly DisagreeRelationships (1) Strongly Disagree(2) DisagreeRelationships (2) Disagree(3) NeutralRelationships (3) Neutral(4) AgreeRelationships (4) Agree(5) Strongly AgreeRelationships (5) Strongly AgreeInsight(1) Strongly DisagreeInsight (1) Strongly Disagree(2) DisagreeInsight (2) Disagree(3) NeutralInsight (3) Neutral(4) AgreeInsight (4) Agree(5) Strongly AgreeInsight (5) Strongly Agree My Counselor at Anchorpoint treated me…. * (1) Strongly Disagree(2) Disagree(3) Neutral(4) Agree(5) Strongly Agree Respectfully(1) Strongly DisagreeRespectfully (1) Strongly Disagree(2) DisagreeRespectfully (2) Disagree(3) NeutralRespectfully (3) Neutral(4) AgreeRespectfully (4) Agree(5) Strongly AgreeRespectfully (5) Strongly AgreeCompassionately(1) Strongly DisagreeCompassionately (1) Strongly Disagree(2) DisagreeCompassionately (2) Disagree(3) NeutralCompassionately (3) Neutral(4) AgreeCompassionately (4) Agree(5) Strongly AgreeCompassionately (5) Strongly AgreeProfessionally(1) Strongly DisagreeProfessionally (1) Strongly Disagree(2) DisagreeProfessionally (2) Disagree(3) NeutralProfessionally (3) Neutral(4) AgreeProfessionally (4) Agree(5) Strongly AgreeProfessionally (5) Strongly AgreeCollaboratively(1) Strongly DisagreeCollaboratively (1) Strongly Disagree(2) DisagreeCollaboratively (2) Disagree(3) NeutralCollaboratively (3) Neutral(4) AgreeCollaboratively (4) Agree(5) Strongly AgreeCollaboratively (5) Strongly AgreeCompetently(1) Strongly DisagreeCompetently (1) Strongly Disagree(2) DisagreeCompetently (2) Disagree(3) NeutralCompetently (3) Neutral(4) AgreeCompetently (4) Agree(5) Strongly AgreeCompetently (5) Strongly AgreeWith Understanding(1) Strongly DisagreeWith Understanding (1) Strongly Disagree(2) DisagreeWith Understanding (2) Disagree(3) NeutralWith Understanding (3) Neutral(4) AgreeWith Understanding (4) Agree(5) Strongly AgreeWith Understanding (5) Strongly Agree Counseling has changed/impacted my life by: *Additional comments or concerns:Your Age: *NameSubmit
