* 1. Date


* 2. Approximately, how many times have you contacted us or had appointments?

* 3. What type of service did you have?

* 4. Did you feel heard, understood and respected by your worker?

* 5. Did you feel comfortable speaking with your worker?

* 6. Was your worker’s approach a good fit for you?

* 7. Did you feel listened to and able to talk about what you wanted?

* 8. Overall, has your quality of life improved since coming to the Crisis team?

* 9. Since coming to the Crisis team, do you feel more able to deal with the current challenges in your life?

* 10. Do you feel safer/more protected from harm?

* 11. What do you feel you benefitted most from?

* 12. Is there anything that could be done differently in our team?

* 13. Is there any feedback you would like to give to your worker?

* 14. Do you have any further comments about your experience at the service?

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.