Client Satisfaction Survey

4. Optional Contact Information

6. Your Name
8. Your Phone Number (optional)
9. Your Email Address (optional)
11. Follow Up

    Would you like us to follow up with you regarding your responses? Is yes, contact information must be provided above.

    1. Yes
    2. No

15. Survey Questions

17. Contact Source*

    Select your contact with the Madison County Victim Witness program.

    1. In-Person
    2. Phone
    3. Email
    4. Mail
18. Introduction to Program*

    How did you hear about the Madison County Victim Witness program?

    1. Law Enforcement
    2. Prosecutor
    3. Website
    4. Facebook
    5. Letter
    6. Other
20. Satisfaction*

    How satisfied are you with your experience with the Madison County Victim Witness program?

    1. Extremely Satisfied
    2. Satisfied
    3. Neutral
    4. Dissatisfied
    5. Extremely Dissatisfied
21. Future*

    If you needed help in the future, how likely would you be to seek help from the Madison County Victim Witness Program?

    1. Extremely Likely
    2. Likely
    3. Unsure
    4. Unlikely
    5. Extremely Unlikely
23. Additional Comments
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

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