Marsha's Place Client Feedback Survey

2. Gender:

• Male
• Female

3. Is this your first time visiting Marsha’s Place for services?

• Yes
• No
• Not Sure

4. What type of service(s) did you receive? Please check all that apply:

• Pregnancy test
• Ultrasound
• STI test
• Earn While You Learn Program

5. How much do you agree with the statements below?

Space Cell	Strongly Disagree	Disagree	In the Middle	Agree	Strongly Agree
a. I am satisfied and/or happy with the services I received at Marsha’s Place.	a. I am satisfied and/or happy with the services I received at Marsha’s Place.: Strongly Disagree	a. I am satisfied and/or happy with the services I received at Marsha’s Place.: Disagree	a. I am satisfied and/or happy with the services I received at Marsha’s Place.: In the Middle	a. I am satisfied and/or happy with the services I received at Marsha’s Place.: Agree	a. I am satisfied and/or happy with the services I received at Marsha’s Place.: Strongly Agree
b. I felt actively engaged in the programs and services I received.	b. I felt actively engaged in the programs and services I received.: Strongly Disagree	b. I felt actively engaged in the programs and services I received.: Disagree	b. I felt actively engaged in the programs and services I received.: In the Middle	b. I felt actively engaged in the programs and services I received.: Agree	b. I felt actively engaged in the programs and services I received.: Strongly Agree
c. I will be able to apply what I’ve learned in the future.	c. I will be able to apply what I’ve learned in the future.: Strongly Disagree	c. I will be able to apply what I’ve learned in the future.: Disagree	c. I will be able to apply what I’ve learned in the future.: In the Middle	c. I will be able to apply what I’ve learned in the future.: Agree	c. I will be able to apply what I’ve learned in the future.: Strongly Agree
d. The staff were knowledgeable.	d. The staff were knowledgeable.: Strongly Disagree	d. The staff were knowledgeable.: Disagree	d. The staff were knowledgeable.: In the Middle	d. The staff were knowledgeable.: Agree	d. The staff were knowledgeable.: Strongly Agree
e. I felt supported by the staff.	e. I felt supported by the staff.: Strongly Disagree	e. I felt supported by the staff.: Disagree	e. I felt supported by the staff.: In the Middle	e. I felt supported by the staff.: Agree	e. I felt supported by the staff.: Strongly Agree
f. I would recommend Marsha’s Place others.	f. I would recommend Marsha’s Place others.: Strongly Disagree	f. I would recommend Marsha’s Place others.: Disagree	f. I would recommend Marsha’s Place others.: In the Middle	f. I would recommend Marsha’s Place others.: Agree	f. I would recommend Marsha’s Place others.: Strongly Agree