Crisis Response Evaluation * 1. Date Date DD / MM / YYYY * 2. Approximately, how many times have you contacted us or had appointments? * 3. What type of service did you have? Crisis Support Emotional Support Safety Planning Court Support DV Education Case Management Safety Upgrades Keeping Women Safe In Their Homes * 4. Did you feel heard, understood and respected by your worker? Not at all Somewhat Moderately Mostly Absolutely Not at all Somewhat Moderately Mostly Absolutely * 5. Did you feel comfortable speaking with your worker? Not at all Somewhat Moderately Mostly Absolutely Not at all Somewhat Moderately Mostly Absolutely * 6. Was your worker’s approach a good fit for you? Not at all Somewhat Moderately Mostly Absolutely Not at all Somewhat Moderately Mostly Absolutely * 7. Did you feel listened to and able to talk about what you wanted? Not at all Somewhat Moderately Mostly Absolutely Not at all Somewhat Moderately Mostly Absolutely * 8. Overall, has your quality of life improved since coming to the Crisis team? Not at all Somewhat Moderately Mostly Absolutely Not at all Somewhat Moderately Mostly Absolutely * 9. Since coming to the Crisis team, do you feel more able to deal with the current challenges in your life? Not at all Somewhat Moderately Mostly Absolutely Not at all Somewhat Moderately Mostly Absolutely * 10. Do you feel safer/more protected from harm? Not at all Somewhat Moderately Mostly Absolutely Not at all Somewhat Moderately Mostly Absolutely * 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 youWe 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. Done
