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* 1. Safety: I feel physically safe coming to CMHA

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* 2. Safety: I feel emotionally safe coming to CMHA

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* 3. Safety: I felt accepted and understood from the first point of contact

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* 4. Trustworthiness: I trust the people who work here at CMHA

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* 5. Trustworthiness: Information is provided about what to expect from services here.

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* 6. Trustworthiness: I believe that CMHA staff will do what they say they are going to do, when they say they are going to do it

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* 7. Trustworthiness: The people who work here act in a respectful and professional way towards me.

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* 8. Communication: Staff use language I can understand

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* 9. Communication: I find the paperwork easy to understand and complete.

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* 10. Communication: Instructional accomodations are available on request (e.g. large print materials, sign language).

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* 11. Choice: CMHA offers me a choice about which services I receive.

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* 12. Choice: I have some control over when and where to meet and with whom.

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* 13. Choice: CMHA staff listen to my needs, wants and respect my preferences.

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* 14. Choice: Staff check in to see if I need a break from the paperwork or any help with it.

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* 15. Collaboration: Staff work with me instead of doing things for me, unless I ask for their help.

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* 16. Collaboration: Staff and I discuss my goals and how I plan to achieve them but the final decision is mine.

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* 17. Collaboration: I have a say in deciding how things are done here at CMHA (suggestion box, survey, becoming a committee member).

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* 18. Inclusivity: I see others who look like me on posters or brochures

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* 19. Inclusivity: I see images of other families like mine.

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* 20. Inclusivity: Intake forms reflect my choice of gender and personal pronoun/s.

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* 21. Inclusivity: Whenever possible, staff refer me to culturally appropriate services.

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* 22. Inclusivity: My cultural values and practices are understood and respected here.

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* 23. Inclusivity: If I’m not comfortable speaking English, I can speak to staff in my native tongue.

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* 24. Empowerment: CMHA Staff recognize my strengths and skills as well as my challenges.

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* 25. Empowerment: Staff here value me as a person.

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* 26. Empowerment: CMHA Staff support me in learning new skills to be able to reach my goals.

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* 27. Empowerment: I feel stronger as a person because I have been coming to CMHA.

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* 28. Trauma Screening Process: The CMHA Staff explained to me why they asked about difficult experience in my life. (like violence or abuse).

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* 29. Trauma Screening Process: The CMHA Staff are as sensitive as possible when they ask me about difficult or frightening experiences I may have had.

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* 30. Trauma Screening Process: I feel safe talking with CMHA Staff here about my experiences with violence or abuse.

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* 31. Do You Have Any Suggestions for Improvement?

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* 32. To be entered into a draw to win a $10 gift card, please enter your contact information below.

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