Health Liaison and Child Safety Liaison Roles Feedback Form

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* 1. Please select the DVAC site which provided the support

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* 2. Date

Date

Date

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* 3. Initials: (optional)

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* 4. What types of support did you receive? (You can select as many are as relevant)

Going to meetings

Support at appointments

Talking to other services ( e.g. police, hospital, court, child safety, housing, legal services, victim support services)

Emotional support

Information about Domestic Violence

Safety planning

Practical support

Other (please detail)

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* 5. How would you rate the support you have received?

Very Unhappy

Unhappy

Neutral

Happy

Very happy

Very Unhappy

Unhappy

Neutral

Happy

Very happy

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* 6. Based on your experience, would you recommend DVAC to other people?

Yes

No

Unsure

Yes

No

Unsure

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* 7. Do you have any other comments or feedback for DVAC?

Thank you
We appreciate your feedback about our service. Please do not hesitate to contact us with any further suggestions regarding ways we can improve our service to you.