Liaison worksheet to be completed AFTER your appointment

The liaison worksheet is a double questionnaire to be completed by the patient online AFTER one consultation and BEFORE the next one.

This enables:

Memory recall and integration concerning themes and experiences approached in a session
Communication of topics that were not discussed during a session (owing to lack of time, forgetfulness, or simply because the patient felt unable to bring up a particular subject)
Better use of time during a session (factual events of the week can be approached differently, and the agenda can be planned more efficiently).

The liaison worksheet may be completed in French or in English.

Note that the liaison worksheet should ideally be completed and submitted the the evening or the morning after the consultation.

Click here to download the liaison worksheet AFTER your appointment, in English, or complete it online.

First name*
Last name*
Email
Part A (to be completed shortly after the consultation):
1. How do you feel when completing this worksheet (now)?*
2. What was noteworthy for you in our last visit? Thoughts, emotions, new perspectives?*
3. On a scale of 0-10, how would you rate the following? Not at all > A little > Somewhat > Very important > Significant 1 2 3 4 5 6 7 8 9 10
a) Efficacité/utilité de la consultation :*
What helped you?*
What did not help you?*
b) How did you feel connected with your therapist ?*
c) How did you feel committed / involved in the discussion?*
d) How present were you during the consultation?*
e) How emotionally connected did you feel?*
4. What could make your consultation more useful or make it a better experience?*
5. Is there something that you struggled to say or ask?*
6. Did you experience something in our consultation which is similar to your difficulties or problems in everyday life?*
7. What risks did you take during the consultation or what progress have you made that could translate into / positively impact your daily life?*
8. How much were you open responding to questions numbered 1 to 6 (percentage) : %*

Part A (to be completed shortly after the consultation):