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EXHIBIT C <br /> <br />SAMPLE OF ORGANIZATIONS CLIENT SATISFACTION SURVEY <br />(PLEASE INCLUDE BRIEF NARRATIVE OF HOW IT WILL BE SOLICITED) <br /> <br />The Basic Needs Clients Satisfaction Survey is given to clients at two key points during the year. <br />The first one being at the initial intake, then again at recertification. The Behavioral Health survey is <br />distributed during 2 weeks once a year to all patient’s/clients. These surveys are available in both <br />English and Spanish. <br /> <br /> <br />Basic Needs Survey <br /> <br /> <br /> <br />In order to serve you better, we asking for you to take this short survey about you <br />experience with the Davis Street Basic Needs Food and Clothing Programs <br /> <br />1. How long have you been a Basic Needs client? <br /> <br /> Less than one year <br /> 1-2 years <br /> 2-5 years <br /> 5-10 years <br /> Over 10 years <br /> <br />2. How did you first hear about Davis Street’s Basic Needs program? <br /> <br /> Community outreach event <br /> Doctor or other health care professional (counsellor, nurse, therapist) <br /> City worker (police office, City Council member, City staff worker) <br /> School <br /> Referred by friend <br /> Davis Street website <br /> Davis Street pamphlet <br /> Davis Street service (childcare, Stepping Stones, Davis Street Centers, Primary Care) <br /> Other, please specify if possible _________________________ <br /> <br />3. Please indicate how much you agree with the following statements about our Food and Clothing <br />program: <br /> <br /> Strongly <br />Agree <br />Agree Disagree Strongly <br />Disagree <br />N/A (not <br />applicable) <br />I feel welcome in the Basic Needs <br />I feel comfortable asking questions about <br />the Basic Needs services <br /> <br />196