* 1. Name (optional):

* 2. Please indicate if you are a:

* 3. Please identify the Huron-Perth Centre staff member(s) who provided service to you and the counselling program/service you were involved in.

* 4. How long have you been involved with the Huron-Perth Centre?

* 5. How would you rate the quality of service you have received?

* 6. To what extent has our services met your needs?

* 7. Would you recommend our services to others?

* 8. Have the services you received helped you to deal more effectively with your situation?

* 9. Overall, how satisfied are you with the service you have received?

* 10. If you needed help again, would you come back to the Huron-Perth Centre?

* 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.