Victim Services Feedback Form

2. Date:*
   Date:
   Date form is being completed
3. Case #:*
   Please provide your case #.
4. Date of Incident:*
   Date of Incident:
   Please provide the date on which your case occurred.
6. In an effort to provide better service to crime victims and witnesses, the Victim Services Unit would appreciate your assistance in completing this survey. Your responses are confidential.
8. Please rate your overall experience with the Police Department:

   1. Poor
   2. Fair

   1. Good
   2. Exceptional
10. Please rate your overall experience with the victim advocate:

    1. Poor
    2. Fair

    1. Good
    2. Exceptional
12. I received a Victim Rights and Assistance Brochure.

    1. Yes
    2. No
14. I understand the criminal justice system process as it relates to my case because of the information I received from the victim advocate.

    1. Yes
    2. No
16. Please indicate whether you agree or disagree with each statement below:
18. The victim advocate explained victims' rights to me.

    1. Agree
    2. Disagree
20. The victim advocate provided me with emotional support.

    1. Agree
    2. Disagree
22. I feel that I was treated with fairness, dignity, and respect.

    1. Agree
    2. Disagree
24. I received information to help me plan for my safety/Smart 911.

    1. Agree
    2. Disagree
    3. N/A
26. I was provided information about the availability of community resources for emotional or financial assistance.

    1. Agree
    2. Disagree
    3. N/A
28. I received information on how to sign up for VINE or I was registered with VINE (Victim Information and Notification Every Day).

    1. Agree
    2. Disagree
    3. N/A
30. I received information about Crime Victim Compensation.

    1. Agree
    2. Disagree
    3. N/A
32. My phone calls to the victim advocate were returned promptly.

    1. Agree
    2. Disagree
    3. N/A
34. Any other comments on services provided by Victim Services or need for additional assistance:
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field