Exit Client Satisfaction Survey (2021/22) Question Title * 1. In respect to your contact with DVCS can you please rate your satisfaction with the following Very Satisfied Satisfied Neutral Dissatisfied Very dissatisfied Not Applicable Our attention to your safety requirements Our attention to your safety requirements Very Satisfied Our attention to your safety requirements Satisfied Our attention to your safety requirements Neutral Our attention to your safety requirements Dissatisfied Our attention to your safety requirements Very dissatisfied Our attention to your safety requirements Not Applicable Our sensitivity and respect for your cultural identity, disability, family or specific individual needs Our sensitivity and respect for your cultural identity, disability, family or specific individual needs Very Satisfied Our sensitivity and respect for your cultural identity, disability, family or specific individual needs Satisfied Our sensitivity and respect for your cultural identity, disability, family or specific individual needs Neutral Our sensitivity and respect for your cultural identity, disability, family or specific individual needs Dissatisfied Our sensitivity and respect for your cultural identity, disability, family or specific individual needs Very dissatisfied Our sensitivity and respect for your cultural identity, disability, family or specific individual needs Not Applicable Our responsiveness and willingness to provide support Our responsiveness and willingness to provide support Very Satisfied Our responsiveness and willingness to provide support Satisfied Our responsiveness and willingness to provide support Neutral Our responsiveness and willingness to provide support Dissatisfied Our responsiveness and willingness to provide support Very dissatisfied Our responsiveness and willingness to provide support Not Applicable Comments Question Title * 2. Please rate your satisfaction with the information provided to you by DVCS Very satisfied Satisfied Neutral Dissatisfied Very Dissatisfied Not Applicable Easy to understand Easy to understand Very satisfied Easy to understand Satisfied Easy to understand Neutral Easy to understand Dissatisfied Easy to understand Very Dissatisfied Easy to understand Not Applicable Relevant to your needs Relevant to your needs Very satisfied Relevant to your needs Satisfied Relevant to your needs Neutral Relevant to your needs Dissatisfied Relevant to your needs Very Dissatisfied Relevant to your needs Not Applicable Comments Question Title * 3. Please rate your satisfaction with regard to the overall assistance and support you received from DVCS Very satisfied Satisfied Neutral Dissatisfied Very dissatisfied Not Applicable Comments Question Title * 4. Do you have any further feedback, comments or suggestions you would like to provide, if so what are they: Question Title * 5. What is your gender identity? Female Male Non-Binary Transgender Transman Transwoman Intersex Genderqueer Gender Fluid Gender Neutral Sistergirl Brotherboy Other Question Title * 6. What is your sexual orientation? Hetrosexual Same-sex Asexual Bisexual Pansexual Fluid Not sure Other Question Title * 7. What is your cultural identity? Aboriginal and/or Torres Strait Islander Australian Australia Afghanistan Albania Algeria Andorra Angola Argentina Armenia Aruba Austria Bangladesh Barbados Belarus Belgium Bermuda Bhutan Bolivia Bosnia Botswana Brazil Brunei Bulgaria Myanmar (Burma) Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Croatia Cuba Cyprus Czech Republic Colombia Comoros Congo Costa Rica Denmark Dominica Dominican Republic East Timor Ecuador Egypt ElSalvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Faroe Islands Gabon The Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guyana Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Kirbati Korea North Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxemburg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Federated States of Micronesia Moldova Monaco Mongollia Montenegro Morocco Mozambique Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama PNG Paraguay Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts & Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome & Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Tatarstan Thailand Tibet Togo Tonga Trinidad & Tobago Tunisia Turkey Turkemenistan Tuvalu Uganda Ukraine UAE UK USA Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Yeman Zambia Zimbabwe Question Title * 8. Do you identify as having a disability? Yes No Not sure Question Title * 9. Would you like to receive the monthly DVCS Client Newsletter? If yes, please ensure you include your Name and Email address so we can confirm you are a client. Please note if you leave your name you will be identifiable. Name Email Address Question Title * 10. What area of DVCS did you engage with (tick as many as applicable)? Crisis intervention Safety planning Support at the ACT Magistrates or Supreme Court Support with other court related matters Support Groups/Moving On Case Management (YPOP and Staying@Home) Room4Change Emergency accommodation Other (please specify) Submit response >>
