Client Survey

Thank you for using Alouette’s services.

Please help us improve by completing this satisfaction survey. Your responses will be kept private unless you give us permission.

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Name

First

Last

Your Experience

Overall, how would you rate your experience with Alouette?

Please rate your experience on the following topics

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
I felt welcomed	Strongly DisagreeI felt welcomed Strongly Disagree	DisagreeI felt welcomed Disagree	NeutralI felt welcomed Neutral	AgreeI felt welcomed Agree	Strongly AgreeI felt welcomed Strongly Agree
I felt safe	Strongly DisagreeI felt safe Strongly Disagree	DisagreeI felt safe Disagree	NeutralI felt safe Neutral	AgreeI felt safe Agree	Strongly AgreeI felt safe Strongly Agree
I was treated with respect	Strongly DisagreeI was treated with respect Strongly Disagree	DisagreeI was treated with respect Disagree	NeutralI was treated with respect Neutral	AgreeI was treated with respect Agree	Strongly AgreeI was treated with respect Strongly Agree
I help set my own goals	Strongly DisagreeI help set my own goals Strongly Disagree	DisagreeI help set my own goals Disagree	NeutralI help set my own goals Neutral	AgreeI help set my own goals Agree	Strongly AgreeI help set my own goals Strongly Agree
The people helping me stuck with me, no matter what	Strongly DisagreeThe people helping me stuck with me, no matter what Strongly Disagree	DisagreeThe people helping me stuck with me, no matter what Disagree	NeutralThe people helping me stuck with me, no matter what Neutral	AgreeThe people helping me stuck with me, no matter what Agree	Strongly AgreeThe people helping me stuck with me, no matter what Strongly Agree
My cultural and spiritual beliefs were respected	Strongly DisagreeMy cultural and spiritual beliefs were respected Strongly Disagree	DisagreeMy cultural and spiritual beliefs were respected Disagree	NeutralMy cultural and spiritual beliefs were respected Neutral	AgreeMy cultural and spiritual beliefs were respected Agree	Strongly AgreeMy cultural and spiritual beliefs were respected Strongly Agree
I would recommend Alouette's service(s) to others	Strongly DisagreeI would recommend Alouette's service(s) to others Strongly Disagree	DisagreeI would recommend Alouette's service(s) to others Disagree	NeutralI would recommend Alouette's service(s) to others Neutral	AgreeI would recommend Alouette's service(s) to others Agree	Strongly AgreeI would recommend Alouette's service(s) to others Strongly Agree

Which service(s) did you access?

Counselling
Outreach
OAT Clinic

Did your life improve as a result of the service(s)?

What has been the most helpful thing about the services you received in the past 6 months?

Additional comments or suggestions