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Client Evaluation Survey
100%
Exit Survey
Which department assisted you?
Court Advocacy
First Response
Personal Protection Order (PPO)
You were assisted with:
domestic violence
sexual assault
stalking
Advocate's name:
Date of service?
Month
Day
Year
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Feb
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1900
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2049
Please select the answer that best describes your experience for each of the statements below:
Strongly agree
Agree
Neutral/Don't know
Disagree
Strongly Disagree
N/A
The advocate helped me understand my role in the court/PPO process
I received information from my advocate about the medical system
The advocate assisted me in increasing my safety options (emotional/physical)
I know more about domestic violence and/or sexual assault (ex: tactics, minimization, blame, reactions, etc.)
I felt supported during the court proceedings
I was treated with courtesy and respect by my advocate
I was provided with information/referrals about/to community resources (ex: financial assistance, counselling, legal clinics, etc.)
I was satisfied with the support given to help me fill out PPO forms and information about the process
Please indicate any
UNMET
legal needs you still have:
How can we improve services?
Please provide any other feedback you want to share with us:
Please provide your contact information. This information is NOT required, NOT part of public record and will be kept confidential.
First Name
:
Last Name
:
Address 1
:
Address 2
:
City
:
State
:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
District of Columbia
Zip
:
Phone
:
Email Address
:
Thank you for taking the time to provide us with this information. Your feedback will help us improve our services. If you would like to speak with someone about your experience or if you have additional concerns, please call the Social Action Program Director at
248-334-1284, ext. 670.
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