Victim Services Survey

Please note that if you choose to fill your survey out anonymously,
it will NOT be entered into our monthly gas card drawing.

OPTIONAL Contact Information:

Name *

First

Last

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

* Indicates required field

1. - Was the Pearl Crisis Center staff knowledgeable in your area(s) of need? *

Yes No

If 'NO' please explain: *

2. - Did the Pearl staff treat you with respect? *

Yes No

If 'NO', please explain: *

3. - Did the staff at Pearl inform you of your confidentiality (Data Privacy) and mandated reporting requirements? *

Yes No

If 'NO', please explain: *

4. - Do you feel that Pearl is a safe place to receive services? *

Yes No

If 'NO', please explain: *

5. - What is something NEW you learned at Pearl? *

6. - Were there any services you felt you needed that were not provided to you by Pearl? *

Yes No

If 'YES', please explain: *

Other Comments: *

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