EVALUATION FORM

The following Evaluation Form provides an anonymous way for you to evaluate NLSACPC services and resources, and submit feedback about your experience. To complete the form, select a response where appropriate, or type in the field provided. It is not required, but should you wish to leave your email address to allow us to reply to your comments, you may use section 5. Remember to click the SUBMIT BUTTON at the bottom of the page when you are finished. Clicking the RESET button will clear your results.

If you have used more than one service, please feel free to complete an individual survey for each service.

Thank you for your comments. Your input is greatly appreciated.

1. Please select a response for each of the following 3 categories:

 

           Female Male            Click here to view a Regional Map.

 

2. How did you hear about the Centre?

 

3. Please check the NLSACPC SERVICE or resource you wish to evaluate:

crisis line

peer support (in person)

hospital accompaniment

support group

referral

educational presentation(s)

pamphlet/written information

website

other

If other, please specify:

 

4. How would you EVALUATE your overall experience of the service you selected above?

 Very Poor     Poor     Adequate     Good     Very Good     Not sure

 

5. Please provide any additional comments or suggestions:

 

      

 

 
 

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Newfoundland and Labrador Sexual Assault Crisis & Prevention Centre

360 Topsail Rd. Suite 101 St. John's NL Canada A1E 2B6 Tel: (709) 747-7757 Fax: (709) 747-7758

www.nlsacpc.com