Crisis Line Feedback Form
For the purpose of identifying the crisis counselor you interacted with, please list the date and time you called the crisis line.
Your answer
The crisis line advocate respected my background (e.g. gender, race, culture, ethnicity, sexuality, disability, etc.) *
Strongly Disagree
Strongly Agree
The crisis line service was available to me at the time that I called . *
The services I received helped me deal more effectively with question/concern. *
Strongly Disagree
Strongly Agree
I would return to this agency if I needed crisis counseling or referral services in the future. *
Strongly Disagree
Strongly Agree
I would recommend this agency to a friend in need of victim services *
Strongly Disagree
Strongly Agree
In an overall, general sense, I am satisfied with the services I received. *
Strongly Disagree
Strongly Agree
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