Janus Associates Client Survey

In an effort to facilitate a positive experience with the process of counselling at JANUS ASSOCIATES we ask that you complete this form at your convenience. There is no need to place your name on this form, however, you may choose to do so if you wish to discuss any of your responses. Thank-you for your assistance.

Background Information
Sex: Male  Female  
Type of counselling: Individual Couple Family
Ages: Under 13 13 - 18 19 - 25
  25 - 40 40 - 49 50 - 59
  Over 59    
       
How did you learn about Janus Associates?
Dr.'s referral   Friend or family member
Website   Yellow Pages
Been to Janus before
Company Employee and Family Assistance Program (EFAP or EAP)
Other
       
If you accessed through an EAP, how were you made aware of it?
Brochure Supervisor
In-house training Newsletter
Union representative Occupational Health
Poster Word-of-mouth
Human Resources lunch time session
Other (specify)
Your company's name:
How many sessions have you had with your counsellor?
     
Intake Procedure    
Was your call answered within 3 - 4 rings? Yes No
Were you placed on hold? Yes No
Did you complete your call? Yes No
How responsive were the intake staff to your needs and requests?
Completely as expected 5 4 3 2 1 Not at all responsive
How satisfied were you when your first appointment was booked?
Very  5 4 3 2 1 Quite disappointed
How did you feel about your initial call?
Very positive  5 4 3 2 1 Very negative
Comments regarding the intake procedure (from calling to meeting with your counsellor):
 
Your counsellors name:
How comfortable are/were you with your counsellor?
Very  5 4 3 2 1 Not at all
How satisfied are/were you with the treatment plan produced with your counsellor?
Very  5 4 3 2 1 Not at all
How satisfied are/were you with your counselling experience at Janus?
Very  5 4 3 2 1 Not at all
How helpful is/was your counselling experience?
Very  5 4 3 2 1 Not at all
How much does/did your counselling impact your work?
Not Applicable
Very helpful 5 4 3 2 1 Not at all
       
Comments or suggestions regarding your counsellor and experience at Janus:
Would you return to Janus if needed? Yes No
Would you recommend this service to other employees? Yes No
Name (optional)
Would you like to be contacted to discuss this further? Yes No
If yes, how can we best contact you?

Alternately, if you have comments, concerns, or suggestions you can phone phone 269-9600 and ask to speak with Dr. Ferris or Dr. Habke.