Client Questionnaire

In order to be able to provide better services to you, the Community Legal Clinic would like to ask you some questions.

First, we would like to ask you some questions about yourself.

1. What is your gender

Male

Female

Other (please explain)

2. What is your age?

3. What is your marital status?

4. What language do you speak most often at home?

English

French

Other (Please explain)

5. What is your current employment status?

Employed full-time

Employed part-time

Self-employed

Full-time student

Part-time student

Disability (ODSP or CPP-D or Worker's Comp)

Government pension (CCP or OAS)

Ontario Works

Unemployed

6. Are you a member of a visible minority group?

Yes

No

Don't know

7. Are you an Aboriginal person?

Yes

No

Don't know

8. From where I live the Community Legal Clinic's services are offered:

Less than two hours away (return trip)

Approximately two hours away (return trip)

More than two hours away (return trip)

9a. Do you have access to (Please check all that apply):

Telephone

Cell phone

Smart phone

Computer (not connected to the internet)

Computer (connected to the internet)

Other (Please explain)

9b. Which of these do you use on a daily basis? (Please check all that apply)

Telephone (connected to a line

Cell phone

Smart phone

Computer (not connected to the internet)

Computer (connected to the internet)

Other (Please explain)

Next ... please tell us about the kind of legal issues and problems that you are facing OR that are important to you. We are also interested in knowing more about your use of internet sites (including your experience and comfort level):

10. Have you ever looked on the internet for legal information?

Always

Occasionally

Never

Do not have a computer

If yes, is the internet a good way to find legal information? Yes OR No

11. What kind of help do you want when you have a legal problem?(Please check all thatapply)

Legal information

Help with filling out forms

Advice on what to do

Someone to represent me

Mediation

Help with service referral

Other help (Please explain)

12. Which way would you prefer to get legal help or advice?(Please check all that apply)

Face to face

Face to face on a smart phone

Telephone

Email

Video conference

Interactive website (discuss your issues with a person on-line)

Other (Please explain)

13. What barriers do you face in accessing legal services? Please check all that apply

Distance to travel

No services available

Transportation issues

Clinic hours

Fees/cost (i.e. don't qualify)

Accessibility Issues (i.e. no wheelchair ramp)

Other (i.e language, reading problems, no phone)

Finally, please tell us about your experiences accessing services from the Community Legal Clinic in your area. We would like you to tell us more about the kinds of problems you were needing help with.

14a. Have you had any problems in the past year that led you to seek help from a Community Legal Clinic? (If yes, see below)

Yes

No

Not applicable

14 b. If yes, what was the nature of your problem? (Please check all that apply)

15. How did you find out about the Community Legal Clinic?

Telephone listings

Information from family or friends

Through the internet

Information from a courthouse or police

Information from an organization/agency/government office

Other method (please explain)

16. Have you ever attended a workshop put on by the Community Legal Clinic?

No

Yes (What was the workshop and was it helpful? )

17. Which of the following best describes how your legal issue was handled by the Community Legal Clinic?

Yes, it was solved

No, it was not solved but I did not want to do anything more about it

No, it was not solved and I do not know what to do

No, it was not solved but I am still working to solve it

My case is still pending

Other (Please explain)

18. Are you satisfied with the way in which your legal problem was handled?

19. At any point during your legal problem, did you represent yourself before a tribunal/board?

20. Please read through the following sentences and indicate what your experience has been
(Please check all that apply )

When I called the Community Legal Clinic (CLC) for service....

21a. The Community Legal Clinic also helped me with other issues I had (i.e. besides legal issues):

Yes

No

21b. If YES PLEASE answer the following (Select all that apply):

The Community Legal Clinic connected me to people in the community who could help me.

The Community Legal Clinic connected me to an organization(s) that could help me.

The Community Legal Clinic gave me practical help i.e. let me use the phone, computer, gave me a bus ticket, helped me to read something.

The Community Legal Clinic connected me with other people who were dealing with the same problems/issue.

Other

22. PLEASE indicate the areas in which you needed help (Select all that apply):

23. Overall, I am _______________ with the services I received from the Community Legal Clinic.

24. Is there anything else you would like to add? (in box below)

Thank you for sharing your experiences with us...your feedback will help us to better serve you!