Wellness Cell — Post-Session Concern / Feedback Form

Name (optional)

Student ID (optional)

Programme / Year (optional)

Date of Counselling Session

Counsellor assigned (if known)

Which of the following concerns did you experience? (select all that apply)

If "Other", please specify

Please describe what made you uncomfortable (optional)

Was there any behaviour or statement from the counsellor that concerned you?

Yes No Prefer not to say

If yes, please explain (optional)

Would you like the Wellness Cell to contact you for follow-up support?

Yes, please reach out No, I would prefer to remain anonymous I am not sure yet

If yes, preferred mode of contact

Email Phone WhatsApp Other

Contact details (if you want to be contacted)

Would you prefer to be assigned a different counsellor for future sessions?

Yes No Maybe / Not sure

If yes, do you have a gender preference?

Male counsellor Female counsellor No preference

Any suggestions to improve your counselling experience? (optional)

By submitting, I understand my feedback will be reviewed confidentially by the Wellness Cell coordination team for quality and safety purposes.