Confidential Survey Confidential Survey This survey is confidential and your identity will remain anonymous unless you state your name and contact information under the “comments” section. 1. Check the name of the counselor you saw at FSAO:Bonnie Teitleman, LICSWKaren Brouhard, LICSW2. Are you satisfied with the services you received at FSAO?Not at allSlightlyModeratelyMostlyVery much3. How much is the problem you sought counseling for at FSAO currently affecting your personal life situation?Not at allSlightlyModeratelyMostlyVery much4. How much is the problem you sought counseling for at FSAO currently affecting your work situation?Not at allSlightlyModeratelyMostlyVery much5. The professional I worked with understood my problem.Not at allSlightlyModeratelyMostlyVery much6. I was better able to cope with my situation after my contact with FSAO.Not at allSlightlyModeratelyMostlyVery much7. Were you referred by FSAO staff to a specialist outside of BU?YesNo8. Did you follow up on your referral?YesNoN/a9. What is the name of the person you were referred to?10. How pleased are you with your experience seeing the specialist you were referred to?Not at allSlightlyModeratelyMostlyVery much11. Please share any additional comments that you might have:12. I would recommend the FSAO to colleagues, family members and others.Not at allSlightlyModeratelyMostlyVery muchNameThis field is for validation purposes and should be left unchanged.