Questionnaire for Clients | Centre Against Violence

Your name (optional) *By providing your name the quality managers are able to discuss with you any issues raised.

Your worker’s name:

Which services were you involved with? (please select one) *Your feedback is confidential

Was the service you selected above adequately described to you in terms of waiting lists, eligibility, fees etc? (please select yes or no)

Yes No

Considering your particular needs, how appropriate were the services you have received? (please select)

Highly appropriate Generally appropriate Generally inappropriate Highly inappropriate

To what extent have services met your needs? (please select)

Almost all needs have been met Most of my needs have been met Only a few needs met None of my needs met

Have the services you received helped you deal more effectively with your situation? (please circle)

Yes they helped a great deal Yes they helped somewhat No they didn’t really help No they seemed to make things worse

My worker helped me better understand my situation

Strongly agree Agree Disagree Strongly Disagree

My worker was competent and knowledgeable