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Initial Client Satisfaction Survey
Hello! As a registered charity offering more accessible counselling services for mental health, we rely on feedback from our clients to ensure we are providing the best service possible in the way you need them most. Your responses will be used to assess and improve clinic functions and client satisfaction.

This form is anonymous, confidential, and optional; once you submit your survey there will be no way to identify you. Responses will be shared with Just Us Executive Director to evaluate and improve client satisfaction, clinic policies, agency programs, and clinic practices.

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Do you have Health Insurance  *
Do you feel the struggles you booked an appointment for, were addressed?  *
Required
Just Us aims to provide timely health care. Do you feel like you received support without a long wait? *
If this program didn't exist where would you have gone to access support for your mental health? *
Required
Do you feel like you are learning the coping skills to navigate life's ups and downs? 
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Please share anything you would like our interning counsellors to know (i.e,. the skills you have learned, the connection with your counsellor etc.)
What could be done to improve your experience to have better met your needs?
Please share anything you would like our donors to know about how Just Us Programs have helped you to feel better and/or improved your life?  *
Do you give permission for your feedback/comments to be used in our communications (e.g., website, social media, donor newsletter)?
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If yes, how do you want your identity to appear? (check all that you are comfortable with and type these identity markers in the question below):
Please sign below with the identifiers you indicated you were comfortable with from the question above (Example: D.T., Male, Age 52).
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