* 1. What is your gender Identity?

* 2. Age

* 3. Please indicate if you have received any of these services from Community Connections

* 4. How helpful and relevant was the service(s)/information you received?

* 5. Were you satisfied with the service(s) you received?

* 6. Did our service(s) have a positive effect for you?

* 7. After receiving our service(s), do you feel that your emotional wellbeing is:

* 8. After receiving our service(s), do you feel that your physical health is:

* 9. After receiving our service(s), do you feel that your relationship with your family is:

* 10. After receiving our service(s), do you feel that your relationship with your social group is:

* 11. How courteous/caring/attentive/respectful were our staff in responding to your needs?

* 12. Please use this space to comment further or elaborate on any of your above responses

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