Breakaway Feedback Form

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We want to get feedback about our work! Please use this form to tell us what you want to see done or changed in our work. Filling out this form helps us improve the quality of our services for service users, by service users.

** Please note, this is not the avenue for clients to make a formal complaint. If you are a client and want to report/address a specific issue please send an email to Nicola Bangham, our Executive Director at nicolab@breakawaycs.ca or call 416-537-9346 ext.444

Name (First and Last), not required but encouraged

Who is/was your Breakaway worker(s)?

What program/service(s) do/did you access at Breakaway? *

Satellite/HRCST

TOST (Toronto Opiate Support Team)

Pieces to Pathways

GLoW (Grief Loss and Wellness)

Through Ruff Times

FYI (Family and Youth Initiative)

ASH (Addiction Supportive Housing)

Prefer not to answer

If you are/were accessing more than one program at Breakaway, please list the program you are/were accessing services with. *

How long have/did you access Breakaway services?

Please provide any feedback you would like us to know

Would you like a manager to follow up with you about your feedback?

Yes

Clear selection

Anything else you would like us to know?

Submit

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