Tu Casa Client Satisfaction Survey

Question Title

* 1. Survey administered by:

Question Title

* 2. Please enter the date you completed this survey:

Question Title

* 3. Where did you access Tu Casa's services?

Alamosa office

Other

Other (please specify)

Question Title

* 4. What services did Tu Casa provide for you? Please check all that apply.

24-hour hotline services

Victim Advocacy

Child Advocacy

Shelter

Protection Order Modification - Education Session

Protection Order Modification - Individual Counseling

Protection Order Modification - Parenting Class

Group Counseling

Individual Counseling - New Client (1-4 completed sessions)

Individual Counseling - Ongoing Client (4+ completed sessions)

Empowerment Classes

Other (please specify)

Question Title

* 5. How satisfied were you with Tu Casa's services?

Not at all

Somewhat

Satisfied

Very satisfied

Question Title

* 6. Did Tu Casa helped you meet the following needs?:

	YES	NO	N/A
Safety	Safety YES	Safety NO	Safety N/A
Food & Supplies	Food & Supplies YES	Food & Supplies NO	Food & Supplies N/A
Shelter	Shelter YES	Shelter NO	Shelter N/A
Clothing	Clothing YES	Clothing NO	Clothing N/A
Housing	Housing YES	Housing NO	Housing N/A
Employment	Employment YES	Employment NO	Employment N/A
Healthcare	Healthcare YES	Healthcare NO	Healthcare N/A
Mental Healthcare	Mental Healthcare YES	Mental Healthcare NO	Mental Healthcare N/A
Education	Education YES	Education NO	Education N/A

Other (please specify)

Question Title

* 7. Please answer the following questions:

	Yes	No	N/A
Were you treated with respect, fairness, and dignity while receiving services at Tu Casa?	Were you treated with respect, fairness, and dignity while receiving services at Tu Casa? Yes	Were you treated with respect, fairness, and dignity while receiving services at Tu Casa? No	Were you treated with respect, fairness, and dignity while receiving services at Tu Casa? N/A
Did you receive services/assistance in a timely manner?	Did you receive services/assistance in a timely manner? Yes	Did you receive services/assistance in a timely manner? No	Did you receive services/assistance in a timely manner? N/A
Did you feel there were adequate accommodations made for language, disabilities, etc?	Did you feel there were adequate accommodations made for language, disabilities, etc? Yes	Did you feel there were adequate accommodations made for language, disabilities, etc? No	Did you feel there were adequate accommodations made for language, disabilities, etc? N/A
Did our advocate/counselor inform you about other available social services/resources?	Did our advocate/counselor inform you about other available social services/resources? Yes	Did our advocate/counselor inform you about other available social services/resources? No	Did our advocate/counselor inform you about other available social services/resources? N/A
Do you feel safer as a result of our services?	Do you feel safer as a result of our services? Yes	Do you feel safer as a result of our services? No	Do you feel safer as a result of our services? N/A
Do you know more about your rights and options as a result of our services?	Do you know more about your rights and options as a result of our services? Yes	Do you know more about your rights and options as a result of our services? No	Do you know more about your rights and options as a result of our services? N/A
Do you know more ways to plan for your safety and more about community resources?	Do you know more ways to plan for your safety and more about community resources? Yes	Do you know more ways to plan for your safety and more about community resources? No	Do you know more ways to plan for your safety and more about community resources? N/A
Do you feel less alone in your experience, more confident that you will achieve your goals, and more hopeful about the future?	Do you feel less alone in your experience, more confident that you will achieve your goals, and more hopeful about the future? Yes	Do you feel less alone in your experience, more confident that you will achieve your goals, and more hopeful about the future? No	Do you feel less alone in your experience, more confident that you will achieve your goals, and more hopeful about the future? N/A
Were Tu Casa's services easy to access or obtain?	Were Tu Casa's services easy to access or obtain? Yes	Were Tu Casa's services easy to access or obtain? No	Were Tu Casa's services easy to access or obtain? N/A

If no, please explain ways to make services more accessible.

Question Title

* 8. How did you find out about Tu Casa?

Friend

Family Member

Department of Social Services

Church/Religious Organization

Mental Health Center

Radio

Newspaper

Other (please specify)

Question Title

* 9. Will you come back to Tu Casa in the future?

Yes

Why or why not?

Question Title

* 10. Would you recommend our agency to others?

Yes

Why or why not?

Tu Casa Client Satisfaction Survey

Question Title

* 1. Survey administered by:

Question Title

* 2. Please enter the date you completed this survey:

Question Title

* 3. Where did you access Tu Casa's services?

Question Title

* 4. What services did Tu Casa provide for you? Please check all that apply.

Question Title

* 5. How satisfied were you with Tu Casa's services?

Question Title

* 6. Did Tu Casa helped you meet the following needs?:

Question Title

* 7. Please answer the following questions:

Question Title

* 8. How did you find out about Tu Casa?

Question Title

* 9. Will you come back to Tu Casa in the future?

Question Title

* 10. Would you recommend our agency to others?

Question Title

* 11. What are you doing differently in your life as a result of receiving Tu Casa's services?

Question Title

* 12. Comments about services you received at Tu Casa: