* 1. I felt respected by the staff.

* 2. I felt the staff understood and respected the trauma I have been through.

* 3. I felt I could make my own decisions without being judged for them.

* 4. Please answer the following questions concerning staff availability.

  Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree
The staff responded promptly to my phone calls.
The staff always arrived to our meetings on time.
The office was open hours that worked with my schedule.

* 5. I was easily able to locate the office.

* 6. Please answer the following questions concerning safety planning.

  Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree
I now have a safety plan in place.
I understand the importance of following my safety plan.
I feel my safety plan is realistic or possible to follow.
I feel my safety plan will help to keep me safe.

* 7. I feel the services I recieved were provided in a way that was respectful of my culture.

* 8. What other services would you like to see offered?

* 9. What would you improve about the services you were provided?

* 10. Would you refer a friend to the TimeOut Shelter? Why or why not?

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