Peer Counselor Impact Survey Form
Help us understand the impact of peer counseling by sharing your honest feedback. Your responses are anonymous and will guide future improvements.
How satisfied are you with your overall peer counseling experience?
*
1
2
3
4
5
To what extent do you agree: 'My peer counselor listened to me respectfully.'
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
To what extent do you agree: 'Peer counseling helped me feel more supported.'
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
How likely are you to recommend peer counseling to others?
*
Not at all likely
1
2
3
4
Extremely likely
5
1 is Not at all likely, 5 is Extremely likely
Which of the following best describes the impact of peer counseling on your well-being?
*
Significant positive impact
Some positive impact
Neutral or no impact
Some negative impact
Significant negative impact
How many peer counseling sessions have you attended?
*
Please Select
1 session
2–3 sessions
4–5 sessions
6 or more sessions
Did you feel comfortable sharing your concerns with your peer counselor?
*
Yes, completely comfortable
Somewhat comfortable
Not very comfortable
Not at all comfortable
What did you find most helpful about your peer counseling experience?
What could be improved in the peer counseling program?
Any additional comments or suggestions?
Submit Feedback
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