In crisis? Contact us at 319-362-2174 or 988.

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Crisis Center Client Feedback Form

Crisis Center Client Feedback Form

Thank you for taking the time to provide feedback about the Foundation 2 Crisis Center. We continually strive to improve our services and value all feedback from those who utilize our programs. For assistance, please call 319-362-1170.

What Crisis Center services did you receive?*
- Phone call
- Chat
- Text
- Other
I felt like my privacy was respected during my services.*
- 1 (extremely dissatisfied)
- 2 (somewhat dissatisfied)
- 3 (neutral)
- 4 (somewhat satisfied)
- 5 (extremely satisfied)
I felt like my service provider(s) were nonjudgemental.*
- 1 (extremely dissatisfied)
- 2 (somewhat dissatisfied)
- 3 (neutral)
- 4 (somewhat satisfied)
- 5 (extremely satisfied)
I felt like my service provider(s) were capable and qualified to meet my needs.*
- 1 (extremely dissatisfied)
- 2 (somewhat dissatisfied)
- 3 (neutral)
- 4 (somewhat satisfied)
- 5 (extremely satisfied)
I received services in a timely manner.*
- 1 (extremely dissatisfied)
- 2 (somewhat dissatisfied)
- 3 (neutral)
- 4 (somewhat satisfied)
- 5 (extremely satisfied)
I felt valued by my service provider(s).*
- 1 (extremely dissatisfied)
- 2 (somewhat dissatisfied)
- 3 (neutral)
- 4 (somewhat satisfied)
- 5 (extremely satisfied)
I felt like my service provider(s) listened to me.*
- 1 (extremely dissatisfied)
- 2 (somewhat dissatisfied)
- 3 (neutral)
- 4 (somewhat satisfied)
- 5 (extremely satisfied)
I felt like my service provider(s) let me share my story.*
- 1 (extremely dissatisfied)
- 2 (somewhat dissatisfied)
- 3 (neutral)
- 4 (somewhat satisfied)
- 5 (extremely satisfied)
My thoughts of suicide decreased.*
- 1 (not at all)
- 2 (somewhat)
- 3 (no change)
- 4 (moderate decrease)
- 5 (significant decrease)
- Not applicable
I felt respected by my service provider.*
- 1 (extremely dissatisfied)
- 2 (somewhat dissatisfied)
- 3 (neutural)
- 4 (somewhat satisfied)
- 5 (extremely satisfied)
I felt like my service provider(s) gave me the referrals I needed.*
- 1 (extremely dissatisfied)
- 2 (somewhat dissatisfied)
- 3 (neutural)
- 4 (somewhat satisfied)
- 5 (extremely satisfied)
Please share any additional thoughts or comments about your experience.
Your Name (Optional)
Email or Phone Number (Optional)

If you would like us to reach out to you about your concern or question, please leave your preferred email or phone number.

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305 2nd Ave SE
Cedar Rapids, IA 52401

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