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Youthline Face to Face Counselling Feedback Form

Youthline needs your help to maintain and improve the service it provides and to qualify for funding. This is one way you can do something for Youthline and the people who use the service. Please complete this questionnaire and return it to us in the envelope provided. This is an anonymous form. You do not need to put your name on it. Information is used in combined form only.

Have the problems which led you to seek help from Youthline (*)






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To what extent do you think any change was the result of the help you are currently receiving or have received from Youthline (*)






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Would you use Youthline again if you felt the need for further help (*)




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Our aim at Youthline is to provide a service to assist you in taking steps to develop a positive sense of yourself, build your self esteem, personal resources and support and develop the ability to recognise and resolve conflicts.

Overall how satisfied are you with the counselling you are receiving from Youthline (*)






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What was the least satisfactory thing about the service you received at Youthline so far (*)

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What was the most satisfactory thing about the service you received at Youthline so far (*)

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Overall how satisfied are you with the co-ordination of the service for you? (arranging of sessions, venue, etc) (*)






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How could have the assistance or service you received / are receiving been more helpful? (*)

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Please let us know about you! You don’t need to put your name on this.

Age (*)








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Ethnicity (please tick appropriate boxes and expand on details below) (*)






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Ethnicity/iwi/country details

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Gender (*)



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Which area do you live in? (*)







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Counsellors name (*)

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Thank you for your time and help. If there are any other comments you would like to make please include them.

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If you would like to go on Youthline's mailing address to find out about Youthline events and activities, please email your contact details to info@youthline.co.nz

Submit!