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Consultation Evaluation Form

This purpose of this form is to evaluate the effectiveness of the consultation service of the Counseling Center. This service refers to occasions when our staff members assist a third party (parents, faculty, staff, friends, etc) with their concerns about the well being of a University of Alabama student.

Due to privacy concerns, please do not provide the name of the student about whom you were concerned. If you have further concerns or questions, please call us at (205) 348-3863.

Date(s) of Consultation:
Name of Counselor:

Were you contacted within a reasonable amount of time after your first call?

Yes No

Were you provided clear recommendations relating to your concern?

Yes No

Did you perceive that the counselor was responsive to your concerns?

Yes No

If not, what contributed to this perception?

The consultation I received helped me to:

Manage my emotions True False N/A
Respond to student behavior True False N/A
Develop a plan of action    True False N/A
Identify resources True False N/A
Refer the student True False N/A
Follow-up as needed True False N/A

Is there any other opinion about this consultation that you would like to provide?


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