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* 1. Indicate if you are :

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* 2. Did the session assist you in dealing with the problem(s)?

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* 3. How would you rate how things are after having had someone to talk to?

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* 4. In dealing with this problem did it make a difference that you had someone to speak with today?

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* 5. If YES to Q4, how would you have been impacted if you had to have waited to speak with today?

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* 6. If NO to Q4, how long would you have been able to wait before talking about this problem?

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* 7. Did it help you to develop a plan to address the problem(s)?

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* 8. Do you believe that you are able to carry out the plan?

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* 9. Was the session helpful in any other way?

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* 10. If yes to Q9, in what way?

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* 11. Was the service disappointing in any way?

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* 12. If yes to Q11, in what way?

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* 13. Have you sought or will you be seeking further service for the difficulties that brought you to CMHA?

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* 14. If yes to Q13, will you come back to CMHA?

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* 15. Do you have any suggestions that would help us to improve the walk-in counselling service?

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* 16. I would recommend services at CMHA to a friend or relative.

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* 17. In general, my contacts with CMHA employees were respectful and courteous.

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* 18. I feel that my own individuality (e.g. culture, beliefs, feelings, etc) were recognized and respected during my involvement with CMHA.

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