We would be very grateful if you could take a few moments to complete the following questions, which are mostly about your involvement with our agency:please enter agency name
My experience of other agencies
The service I received from other agencies (e.g. Police, Courts, Prosecution, Victim Support) was, on the whole, a service with which I am …
Very Satisfied / Satisfied / Neither Satisfied
nor Unsatisfied / Unsatisfied / Very Unsatisfied
Comments:
The service I received from your agency
(please tick 1 answer per question) / Strongly Agree / Agree / Neither Agree nor Disagree / Disagree / Strongly Disagree
  1. The information was clear

  1. I was able to say everything that I wanted to

  1. I felt listened to

  1. I felt treated with respect and dignity

  1. I was given options to address the impact the offence had on me

Comments:
What I was offered
(please tick 1 answer per question) / I was offered, and accepted / I was offered, and I declined / I was not offered, but would have accepted / I was not offered, and would have declined
  1. To meet the offender

  1. To communicate with the offender without meeting them

  1. To say what I thought should happen (e.g. reparation)

  1. Information about other agencies that could support me

  1. Further information on progress of the case

Comments:
I decided not to communicate with the offender, because: (please tick all the apply)
Your agency decided that it was inappropriate / I was told that the offender was not ready
I was prevented from communicating with the offender / It wasn't made clear to me by someone else what was being offered
I was concerned about my safety / The offence is in the past and I have put it behind me
The matter was already sorted between us / I did not think it worthwhile
I was too busy / I wasn't able to because:
Your agency provided enough information for me to make my own choice to become involved?
Yes Partly No
Comments:
The service provided by your agency was a service with which I am …
Very Satisfied / Satisfied / Neither Satisfied
nor Unsatisfied / Unsatisfied / Very Unsatisfied
Comments:
Your agency provided me with information about making complaints: Yes Partly No
Comments:
Did a restorative process help me
If applicable: / Strongly Agree / Agree / Neither Agree nor Disagree / Disagree / Strongly Disagree
  1. I felt heard by the offender (/other person)

  1. I got what I wanted out of the meeting / communication

  1. Things which would have been more helpful if they had been done differently are:

Comments:
If applicable:
2. In relation to how the agreed reparation (practical work by the offender) was completed, I am:
Very Satisfied / Satisfied / Neither Satisfied
nor Unsatisfied / Unsatisfied / Very Unsatisfied
Comments:
3. I felt better after my contact with your agency: Yes Partly No
Comments:
4. The restorative process was something with which I am:
Very Satisfied / Satisfied / Neither Satisfied
nor Unsatisfied / Unsatisfied / Very Unsatisfied
Comments:
Thank you for your time in completing this form