FEEDBACK FORM We welcome feedback from our clients, partners and public. OK Your completed feedback survey will be automatically sent to the Executive Director at CFWR. Thank you for taking time to provide your input. OK Question Title * 1. My feedback is a: Compliment for something that went well. Concern for a mistake we made or improvement that is needed. Comment/Suggestion/Idea OK Question Title * 2. I am a: Current Client Past Client Member of the Public Service Provider Other (please specify) OK Question Title * 3. What would you like to tell us? OK Question Title * 4. Did you have any concerns or issues accessing our services? Yes No Explanation: OK Question Title * 5. Were your accessibility needs accommodated? Yes No Not Applicable Explanation: OK Question Title * 6. Would you like a response to your feedback? Yes No OK Question Title * 7. If yes, I prefer contact by: Phone Email Letter OK Question Title * 8. Please provide corresponding contact information. Name Address Address 2 City/Town Province Postal Code Email Address Phone Number OK Thank you for your feedback. OK If you have requested a response, the Executive Director will contact you within 7-10 working days. Your personal information will be kept confidential. In addressing your complaint, there may be need to share your information with other people within CFWR. OK DONE