Your name (optional):

Which programs or services did you receive at Solid Ground? Please list all that apply:

On a scale of 1 (low) to 5 (high), do you feel that you were treated respectfully by staff?

Least Respectful  Average  Most Respectful       1 2 3 4 5 N/A TREATMENT by STAFF:

Treatment Comments

On a scale of 1 (low) to 5 (high), did you receive services appropriate to your needs?

Least Appropriate  Average  Most Appropriate       1 2 3 4 5 N/A APPROPRIATENESS of SERVICES:

Appropriate Services Comments

On a scale of 1 (low) to 5 (high), how would you rank staff’s understanding and respect of your culture?

Worst Understanding  Average  Best Understanding       1 2 3 4 5 N/A RESPECT of CULTURE:

Culture Respect Comments

On a scale of 1 (low) to 5 (high), did staff listen to your concerns and ideas?

Never  Average  All the Time       1 2 3 4 5 N/A LISTENING SKILLS of STAFF:

Listening Concerns Comments

Were you provided an interpreter if needed?

Yes No N/A

What language do you speak in your household?

What challenges did you face, if any, in accessing our services? (Transportation, time and location, etc.)

How do you think we could improve our services? What would you keep the same?

Are you interested in joining our client Advisory Council to provide regular feedback to Solid Ground? If yes, please fill in your name and phone number, email and/or mailing address below. (For more information about our Advisory Council, please contact Ariana Cantu at arianac@solid-ground.org or 206.694.6860.)

Name:

Phone Number:

Email Address:

Mailing Address:

On a scale of 1 (low) to 5 (high), how would you rate the services that you received at Solid Ground?

Worst  Average  Best       1 2 3 4 5 N/A SERVICES YOU RECEIVED:

Services Received Comments

Would you recommend Solid Ground to others?

Yes No

Please share with us any final comments about your experience at Solid Ground.