Waterloo Residents Feedback Survey

Community Support Referrals

Did you recently:

a) Contact an agency for a referral?

b) Visited an agency as a result of a referral?

If so, we want to hear how the Referral Process went for you.

Government or Non-Government staff you dealt with during the referral may also have asked you to record your thoughts on this referral on this form.

Completing this form and sharing your feedback will help the Waterloo Human Services Collaborative improve support for residents like you and the wider Waterloo Community.

You can find out more about the Waterloo Collaborative of Government and Non-Government agencies at www.waterloo2017.com

Let's work together to improve Waterloo community support.

Thank you for your time and feedback.

Question Title

* 1. What type of support were you referred for?

Housing

Employment

Health Related

Financial Assistance

Legal issue

Family

Education

Community / Social

Neighbourhood disputes

Emergency Relief

Wellbeing support

Energy Bills other private consumer complaints

Private consumer / retail complaints

Other (please specify)

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* 2. Have you tried to get support for this from other agencies before this referral?

Yes

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* 3. How Many agencies have you approached for help with this issue?

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* 4. Did you find the help you were wanting from this latest referral?

Yes

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* 5. Overall, how satisfied were you with the referral process?

Very Satisfied

Satisfied

Neutral

Dissatisfied

Very Dissatisfied

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* 6. On your latest referral, the referring agency (select all that are applicable)

Respected my confidentiality

Explained their consent procedures clearly

Clearly explained the steps of the referral process and the expected time frame and did not give me unrealistic promises about the outcome of the referral.

Respected my choices and decisions

Prioritised my Safety

Followed up with me to make sure the referral was appropriate

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* 7. On your latest referral, the agency I was referred to: (select all that are applicable)

Responded in reasonable time

Was able to assist

My issue was resolved

My issue is unresolved

I was referred to another agency

The referral process, the expected time frame and outcomes were similar to what I had been told to expect

Respected my choices and decisions

Prioritised my Safety

Respected my confidentiality

Offered to provide feedback to the referring agency

Other (please specify)

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* 8. Did the referral meet your expectations?

Yes

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* 9. Please share any challenges or obstacles you faced during the referral process.

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* 10. Would you recommend this referral service to others in need?

Definitely Yes

Probably Yes

Not Sure

Probably Not

Definitely Not

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* 11. What improvements would you suggest for the referral process?

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* 12. Are there any other suggestions you would like us to consider for improving local supports

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* 13. Please provide your details if you want to be contacted for future surveys. (This question is optional, and any details entered will only be used for future surveys and not linked with your answers)

Waterloo Residents Feedback Survey

Community Support Referrals

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* 1. What type of support were you referred for?

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* 2. Have you tried to get support for this from other agencies before this referral?

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* 3. How Many agencies have you approached for help with this issue?

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* 4. Did you find the help you were wanting from this latest referral?

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* 5. Overall, how satisfied were you with the referral process?

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* 6. On your latest referral, the referring agency (select all that are applicable)

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* 7. On your latest referral, the agency I was referred to: (select all that are applicable)

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* 8. Did the referral meet your expectations?

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* 9. Please share any challenges or obstacles you faced during the referral process.

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* 10. Would you recommend this referral service to others in need?

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* 11. What improvements would you suggest for the referral process?

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* 12. Are there any other suggestions you would like us to consider for improving local supports

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* 13. Please provide your details if you want to be contacted for future surveys. (This question is optional, and any details entered will only be used for future surveys and not linked with your answers)

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* 14. Email

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* 15. Telephone