Victims Satisfaction Survey

SATISFACTION WITH SERVICES QUESTIONS

(SAMPLE)

To provide the best services possible to you and the other persons who attend our programs, we ask all clients the same set of questions toward the end of services. It should take about less than 5 minutes to answer these questions. The reason we are asking these questions is to help us to get to know whether your needs have been met, and whether you have received the types of services and assistance that you wanted. 

During your time in our program, how much did you learn about how abuse/violence can affect physical and emotional health?

¨  A great deal

¨  A lot

¨  Some

¨  A little bit

¨  Nothing

 

How much did you learn about community resources that are available for help? 

¨  A great deal

¨  A lot

¨  Some

¨  A little bit

¨  Nothing

 

Overall, how would you rate the help that you received through our program?

¨  Extremely helpful

¨  Very helpful

¨  Helpful

¨  A little helpful

¨  Not at all helpful

 

Overall, what aspect or part of the program was most helpful to you? (Record below)

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

 

Overall, what aspect or part of the program was least helpful to you? (Record below)

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

If a friend told you she/he was thinking of coming here for help, what would you recommend to your friend?

¨  Very strongly recommend that she/he come to the program

¨  Strongly recommend that she/he come to the program

¨  Recommend that she/he come to the program

¨  Recommend that she/he NOT come to the program

¨  Strongly recommend that she/he NOT come to the program

Thank you for sharing this information with us.  It will be very helpful in planning for your safety and well-being as you are leaving our program.