Questionnaire for Clients Jul 20, 2015 Your name (optional) *By providing your name the quality managers are able to discuss with you any issues raised. Your worker’s name: Which site did you visit? (please select below) Wodonga Wangartta Benalla Myrtleford Mansfield Which services were you involved with? (please select one) *Your feedback is confidential make a selection…Family ViolenceSexual AssaultUnknown/Other 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 Strongly agree Agree Disagree Strongly disagree My worker encouraged my to make decisions Strongly agree Agree Disagree Strongly disagree Strategies my worker used gave me a sense of independence Strongly agree Agree Disagree Strongly disagree My situation and my feelings about it were not well understood by my worker Strongly Agree Agree Disagree Strongly disagree My worker let me know what was happening next Strongly agree Agree Disagree Strongly disagree My worker demonstrated respect Strongly agree Agree Disagree Strongly disagree I felt is was difficult to refuse a service that wasn’t right for me Strongly agree Agree Disagree Strongly disagree Have you felt that at all times your situations was kept confidential? (please select yes or no) Yes No Accessing this service is something I would do or not do because…. Please state any further comments, advice or suggestions you would like to make… Please state any further comments, advice or suggestions you would like to make…