Client Feedback Question Title * 1. Do you feel comfortable with your worker/counsellor? Very comfortable Comfortable Uncertain Uncomfortable Very Uncomfortable N/A Very comfortable Comfortable Uncertain Uncomfortable Very Uncomfortable N/A Question Title * 2. Do agree with the goals or tasks that you are working on? Strongly Agree Agree Uncertain Disagree Strongly Disagree N/A Strongly Agree Agree Uncertain Disagree Strongly Disagree N/A Question Title * 3. Do you feel like things will get better with help from your worker/counsellor? Strongly Agree Agree Uncertain Disagree Strongly Disagree N/A Strongly Agree Agree Uncertain Disagree Strongly Disagree N/A Question Title * 4. Do you feel welcomed at The John Howard Society of North Island? Always Often Sometimes Rarely Never N/A Always Often Sometimes Rarely Never N/A Question Title * 5. Do you feel “heard” by staff? Yes No N/A Yes No N/A Question Title * 6. Do you feel that we are respectful towards you? Always Often Sometimes Rarely Never N/A Always Often Sometimes Rarely Never N/A Question Title * 7. Do you feel that your worker/counsellor keeps things confidential? Always Often Sometimes Rarely Never N/A Always Often Sometimes Rarely Never N/A Question Title * 8. Are you able to get a hold of your worker/counsellor easily? Always Often Sometimes Rarely Never N/A Always Often Sometimes Rarely Never N/A Question Title * 9. Did you receive the services that you needed? Strongly Agree Agree Uncertain Disagree Strongly Disagree N/A Strongly Agree Agree Uncertain Disagree Strongly Disagree N/A Question Title * 10. What do you find difficult or frustrating about coming in to use our services? Question Title * 11. What do you like about our services? Question Title * 12. Would you refer a friend or family member to one of our programs if they were struggling with something? Definitely will Probably will Maybe Probably won’t Definitely won’t N/A Definitely will Probably will Maybe Probably won’t Definitely won’t N/A Question Title * 13. Are you aware of how to make a complaint if you need to? Yes No N/A Yes No N/A Question Title * 14. For parents:Do you feel included/kept in the loop? Always Often Sometimes Rarely Never N/A Always Often Sometimes Rarely Never N/A Question Title * 15. For parents:Do you feel better able to give guidance and support to your teen? Strongly Agree Agree Uncertain Disagree Strongly Disagree N/A Strongly Agree Agree Uncertain Disagree Strongly Disagree N/A Question Title * 16. We want to learn from our mistakes and improve our services where we need to. Do you have any comments or suggestions that will help us to make those changes? Done
