Domestic abuse service user questionnaire
We are asking you to complete this short form, about your experience of contacting agencies about any domestic abuse you have experienced. Your responses will help us to improve our services to meet your needs.

As well as asking you about services, we have included a few questions about you, because we want to know that our services are inclusive and open to everyone who wants to use them.

We will treat any information you provide as confidential but will be used for research and statistical purposes.

About you
How would you describe your gender?
Age group
How would you describe your ethnicity?
Choose one option that best describes your ethnic group or background
How would you describe your sexual identity?
What is your religion?
About the Domestic Abuse
What type of domestic violence or abuse did you/are you experiencing?
Please tick all the types you have experienced
What area did you live in when you experienced the abuse?
Please tick the local authority, who you pay your council tax to
When did you experience the violence or abuse?
About the agencies
Which agencies have you been in contact with?
please tick all the agencies that you have had contacted with in relation to the domestic abuse etc.
If you had no contact with agencies, why not?
Your answer
When you had involvement with the agencies, how did that come about?
When you called initially, what help were looking for?
If you called the agency yourself what was it you were hoping to get from the call?
Which of the services that you contacted did you feel was most helpful ?
You might have had contact with a range of people or services and we are interested in who you found most helpful, Please write the name of the agency
Your answer
What was your experience of this agency?
eg: did they have a good attitude, offered emotional support, gave helpful advice, practical help, felt safer
Your answer
We are interested in your experience of the support you have been offered by this service.
please tick any of these that you feel apply
Overall, do you feel that your life has improved as a result of your contact with services?
What could have made things better?
eg: other services offered, quicker response for support, easier to access
Your answer
Which of the services that you contacted did you feel could have been improved?
You might have had contact with a range of people or services and we are interested in which service you felt could have improved their service, Please write the name of the agency
Your answer
What was your experience of this agency?
Poor attuitdude, poor advice, abusive response (e.g. racist or homophobic language), action taken was unhelpful or put you at risk
Your answer
Overall, do you feel that your life has improved as a result of your contact with services?
What could have made things better?
eg: other services offered, quicker response for support
Your answer
We are interested in finding out about barriers that prevent people experiencing domestic abuse in seeking help
Are there any other comments that you want to make about your experience of domestic abuse and the agencies involved?
Your answer
Thank you for taking the time to complete this form.
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