Name (optional):

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* 1. Name (optional):

Please indicate if you are a:

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* 2. Please indicate if you are a:

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

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

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

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

How would you rate the quality of service you have received?

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

To what extent has our services met your needs?

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

Would you recommend our services to others?

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* 7. Would you recommend our services to others?

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

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

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

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

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

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

Comments and suggestions:

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* 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.

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