Rebuilding Hope Client Survey

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

As the only Accredited Community Sexual Assault Program entrusted to provide Core Sexual Assault Services in Pierce and Kitsap Counties in Washington, Rebuilding Hope calls on current or former clients to provide feedback about their experience receiving agency services. Your feedback is valued by Rebuilding Hope’s board, staff and volunteers, and is critical to the agency’s growth, development and accountability to the community we serve. This is a confidential survey that should take 5-10 minutes to complete. Your responses will remain anonymous when reviewed internally. There are opportunities where you may provide safe contact information should you wish to be contacted about your experience or feedback and/or if you wish to be entered into a quarterly drawing for an e-card for your participation in the survey. If you have any questions regarding this survey, please contact Administration@rebuildinghope.org. Thank you for your time and energy towards this survey.

In what year or over what years did you receive services from Rebuilding Hope?

How did you learn about Rebuilding Hope? Please check all that apply: *

Friend/Family Member

Online Search

Social Media (Facebook, Instagram, etc.)

Community Professional (teacher, attorney, health professional, etc.)

Criminal Justice System (police, prosecutor, court professionals, corrections, etc.)

Other:

Required

What services did you receive from Rebuilding Hope? Please check all that apply: *

Administrative services (front desk/reception)

Advocacy services (24/7 helpline; in-person advocate support, etc.)

Therapy services (individual counseling, couples counseling, support groups etc.)

Prevention education services (presentations, workshops)

Outreach services (tabling at community events, resource fairs, etc.)

I received no services from Rebuilding Hope, but have feedback I wish to provide

Required

How likely are you to recommend a victim/survivor of sexual assault or abuse to Rebuilding Hope for services?
*

Extremely likely

Likely

Neutral

Unlikely

Extremely unlikely

How helpful were the services you received from Rebuilding Hope?
*

Very helpful

Helpful

Neutral

Somewhat helpful

Not at all helpful

How satisfied are you with the staff that assisted or supported you?
*

Completely satisfied

Satisfied

Neutral

Somewhat satisfied

Not at all satisfied

If you faced any barriers to accessing Rebuilding Hope services, please describe them here.

Please provide any additional feedback or comments regarding your experience with Rebuilding Hope.

May we use your anonymous feedback from this survey to share publically as part of the agency's communication to funders, service outreach, training and education? *

Yes

Please contact me to discuss further (complete final question to provide contact info for follow-up)

If you would like to be contacted for follow-up regarding your feedback in this survey, please provide your preferred phone number and/or email address here. Staff who contact you will identify as calling or emailing from Rebuilding Hope and will clarify they are contacting you in response to your client satisfaction survey.

Submit

Clear form

Never submit passwords through Google Forms.

Forms

This form was created inside of Rebuilding Hope Sexual Assault Center.