Victim Survey Form

Please rate the quality of services you received from the Receptionist by scoring the following statements.
  1. I was satisfied with the response of the receptionist.
     Strongly Agree Agree Neither Agree/Disagree Disagree Strongly Disagree
  2. The receptionist was sensitive to my needs.
     Strongly Agree Agree Neither Agree/Disagree Disagree Strongly Disagree
Please rate the quality of services you received from the Advocate by scoring the following statements.
  3. Were the services provided by the Advocate helpful?
     Yes No
  4. What was the name of your victim advocate?
    
  5. Did the Advocate help you solve problems or issues/concerns you had?
     Strongly Agree Agree Neither Agree/Disagree Disagree Strongly Disagree
  6. Did she/he help you understand the criminal justice system and how it related to your case?
     Strongly Agree Agree Neither Agree/Disagree Disagree Strongly Disagree
  7. Did the Advocate explain restitution and/or victim compensation?
     Strongly Agree Agree Neither Agree/Disagree Disagree Strongly Disagree
  8. Did she/he help you exercise your Victim rights?
     Strongly Agree Agree Neither Agree/Disagree Disagree Strongly Disagree
  9. Would you contact police if you were re-victimized in the future?
     Strongly Agree Agree Neither Agree/Disagree Disagree Strongly Disagree
  10. Did the Advocate stay in contact with you throughout the criminal justice process?
     Strongly Agree Agree Neither Agree/Disagree Disagree Strongly Disagree
  11. Did the Advocate go over safety needs with you?
     Strongly Agree Agree Neither Agree/Disagree Disagree Strongly Disagree
  12. Did the Advocate inform you about Orders of Protection or Injunctions Against Harassment?
     Strongly Agree Agree Neither Agree/Disagree Disagree Strongly Disagree
  13. Did you receive emergency services such as parking validation, or in some cases, cabs or grocery vouchers?
     Strongly Agree Agree Neither Agree/Disagree Disagree Strongly Disagree
  14. Did the Advocate treat you with dignity and respect?
     Strongly Agree Agree Neither Agree/Disagree Disagree Strongly Disagree
  15. Did the Advocate give you information on other agencies or support services to assist you?
     Strongly Agree Agree Neither Agree/Disagree Disagree Strongly Disagree
  16. Overall were you satisfied with the services provided by the Advocate and our Victim Services Unit?
     Strongly Agree Agree Neither Agree/Disagree Disagree Strongly Disagree
  17. Were the services provided timely?
     Strongly Agree Agree Neither Agree/Disagree Disagree Strongly Disagree
  18. Were you notified of Victim Rights and court hearings?
     Strongly Agree Agree Neither Agree/Disagree Disagree Strongly Disagree
  19. If you could improve one thing about the Victim Services Unit what would it be?
    
Def. Name
Case #

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