SALT's YYA Feedback Form
We want to hear from you! Please use this form to provide feedback about our programs and services. This will in no way disqualify you from services so please be as honest and as open as possible as we would like to know how we can make your experience better!
How often do use SALT's drop-in services?
Often (ex. daily/weekly)
Sometimes (ex. once per month)
Not often (ex. few times out of the year)
This is my first time
Do the services meet your needs?
Yes
No
Do the services help you to achieve your goals?
Yes
No
If no, please explain
Please rate the following services using the stars, with 1 star being the lowest and 5 stars being the highest.
Showers
1
2
3
4
5
Laundry
1
2
3
4
5
Case Management
1
2
3
4
5
Peer Support
1
2
3
4
5
Spiritual Care
1
2
3
4
5
On a scale of 1 to 10, how satisfied are you with SALT's drop-in service?
Not Satisfied
1
2
3
4
5
6
7
8
9
Extremely Satisfied
10
1 is Not Satisfied, 10 is Extremely Satisfied
On a scale of 1 to 10, how would you rate the communication from staff members?
Not Satisfied
1
2
3
4
5
6
7
8
9
Extremely Satisfied
10
1 is Not Satisfied, 10 is Extremely Satisfied
Is there a particular staff that you would like to tell us about? (something positive or negative)
Yes
No
What is the staff member's name?
What would you like to tell us about this staff member?
on a scale of 1-10, how likely are you to recommend SALT services?
Not likely
1
2
3
4
5
6
7
8
9
Highly likely
10
1 is Not likely, 10 is Highly likely
How can we make our services at SALT better ?
Is there anything else that you would like for us to know ?
Personal Information
What is your name?
I'd rather not say
Submit
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