Client Satisfaction Questionnaire 2018 Question Title * 1. Name (optional): Question Title * 2. Please indicate if you are a: Parent or Guardian of a child/adolescent receiving services Child receiving services (age 11 and under) Adolescent receiving services (age 12-18) Adult receiving services Question Title * 3. Please identify the Huron-Perth Centre staff member(s) who provided service to you and the counselling program/service you were involved in. Program/Service: Huron-Perth Centre staff member(s): Month/Year service ended: Question Title * 4. How long have you been involved with the Huron-Perth Centre? First session 1-3 months 3-6 months 6-12 months 12 months or more Question Title * 5. How would you rate the quality of service you have received? Excellent Good Fair Poor Question Title * 6. To what extent has our services met your needs? Almost all of my needs have been met Most of my needs have been met Only a few of my needs have been met None of my needs have been met Question Title * 7. Would you recommend our services to others? No, definitely not No, I don't think so Yes, I think so Yes, definitely Question Title * 8. Have the services you received helped you to deal more effectively with your situation? Yes, they helped a great deal Yes, they helped No they really didn't help at all No, they seemed to make things worse Question Title * 9. Overall, how satisfied are you with the service you have received? Very satisfied Mostly satisfied Indifferent or mildly dissatisfied Quite dissatisfied Question Title * 10. If you needed help again, would you come back to the Huron-Perth Centre? No, definitely not No, I don't think so Yes, I think so Yes, definitely Question Title * 11. Comments and suggestions: Thank you for your time to complete this questionnaire; we appreciate your assistance. Your feedback will be reviewed on a quarterly basis; if your feedback requires more prompt attention, we invite you to speak to a Clinical Services Manager. Done
