Client Satisfaction Questionnaire 2018

* 1. Name (optional):

* 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

* 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:

* 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

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

Excellent

Good

Fair

Poor

* 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

* 7. Would you recommend our services to others?

No, definitely not

No, I don't think so

Yes, I think so

Yes, definitely

* 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

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

Very satisfied

Mostly satisfied

Indifferent or mildly dissatisfied

Quite dissatisfied

* 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

* 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.