Client Survey Client Survey [En Español] FSA Program * Counseling I-You Venture Senior Outreach Survivors Healing Center WomenCARE Location Santa Cruz Soquel Watsonville Telehealth Date Counselor(s) / Facilitator(s) Are you attending a group? Yes No If so, which group? Other, Other, starting on 01/01/2021 If your group is not listed, choose "Other" and enter the details in the next item. If your group is not listed above, enter the group name, facilitator, and start date below Your evaluation For each item identified below, circle the number to the right that best fits your judgement. Use the rating scale to select the number, from 7 (strongly agree) to 1 (strongly disagree). If the question does not apply to your situation, select n/a. As a result of the services I received... na 1 2 3 4 5 6 7 1. I am better at handling my daily life 7 (strongly agree) 6 5 4 3 2 1 (strongly disagree) n/a 2. I get along better with people in my life 7 (strongly agree) 6 5 4 3 2 1 (strongly disagree) n/a 3. I am doing better at work or school 7 (strongly agree) 6 5 4 3 2 1 (strongly disagree) n/a 4. I am better able to cope when things go wrong 7 (strongly agree) 6 5 4 3 2 1 (strongly disagree) n/a 5. I feel better 7 (strongly agree) 6 5 4 3 2 1 (strongly disagree) n/a 6. I feel less isolated 7 (strongly agree) 6 5 4 3 2 1 (strongly disagree) n/a 7. I am satisfied with the services I received 7 (strongly agree) 6 5 4 3 2 1 (strongly disagree) n/a 8. I got the help I wanted or needed 7 (strongly agree) 6 5 4 3 2 1 (strongly disagree) n/a 9. Program staff were sensitive to my cultural and ethnic background 7 (strongly agree) 6 5 4 3 2 1 (strongly disagree) n/a 10. Program staff treated me with respect 7 (strongly agree) 6 5 4 3 2 1 (strongly disagree) n/a I would recommend the agency to a friend or family member Yes No What did you like best? What would have been helpful? Do we have your permission to use your comments on grant applications and/or newsletters? Yes No Submit
