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Client Evaluation Survey
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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?
MonthDayYear
  
 
 
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 : 
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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