Thank you for agreeing to take part in this important survey evaluating the services you have received at Choices for Change. Your feedback will help us to better serve you in the future.

You are given the opportunity to comment on your responses at end of the survey. Please be assured that all answers you provide will be kept in the strictest confidence.

Responses will be reviewed regularly to ensure ongoing quality improvement.


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* 1. The wait time, location, welcome and orientation to the services I received was appropriate.

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* 2. How helpful have you found our services.

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* 3. As a client of Choices for Change, I was assured of my right to confidentiality.

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* 4. I felt comfortable asking questions and participating in my treatment plan.

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* 5. I was informed of procedures for registering a complaint.

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* 6. As a client of Choices for Change, I found my counsellor(s) to be knowledgeable, competent and motivating. I felt my needs and goals were understood and respected.

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* 7. Overall, I found the facility welcoming, non-discriminating and comfortable. (ie: reception, waiting room, counselling offices, group rooms) I was given a private, safe space when discussing personal issues with staff.

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* 8. Overall, Choices for Change accommodated my needs related to mobility, hearing, vision, and learning.

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* 9. Staff helped me develop a plan for when I leave the services of Choices for Change. Staff helped me identify where to get support after I leave Choices for Change.

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* 10. The services I have received have helped me to deal more effectively with my life’s challenges.

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* 11. Is there anyone you would like us to recognize for outstanding service?

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* 12. Do you have any suggestions to help us improve our service?

Thank you for participating. If you wish (OPTIONAL)  to be contacted regarding concerns you may have expressed in your feedback, please print your name below and provide a contact telephone number or email address where you may be reached.

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* 13. Name:

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* 14. Contact Information:

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