SURVEY

Name

Best way to reach you? Best way to reach you?E-mailTelephone

Is this a secure e-mail address? Is this a secure e-mail address?YesNo

E-mail

Telephone number

Can we leave a voicemail message or text? Can we leave a voicemail message or text? Yes No

Which service(s) did you use? Which service(s) did you use? Shelter Counselling (domestic violence) Counselling (sexual assault) Counselling (other) Transitional support and housing assistance Human trafficking Child witness Support group Workshop Awareness presentation

Where do you live? Where do you live?TimminsIroquois FallsCochraneKapuskasingHearstOther

Other location :

Were the services offered to you virtually or in person? Were the services offered to you virtually or in person? Virtual In person

Did the service you received help you reach your goals? Did the service you received help you reach your goals? Not at all Acceptable Yes Very much

Comments :

Is there anything we could do to improve your experience when accessing our services?

Were you able to reach a worker easily? Were you able to reach a worker easily? Not at all Acceptable Yes Very easily

During intake, were the following clearly explained to you : During intake, were the following clearly explained to you :

The agency's services The agency's services Yes No

Confidentiality agreement Confidentiality agreement Yes No

The role of the worker The role of the worker Yes No

The safety plan The safety plan Yes No

Other comments