Cody Office

1220 13th Street
Cody, WY 82414
Office: 307-587-3545
Fax: 307-587-4353

Powell Office

335 N. Gilbert Street
Powell, WY 82435
Office: 307-754-7959
Fax: 307-754-7959 (call first)
Powell office is handicap accessible ˙

Crisis Intervention Services (CIS): Community Satisfaction Survey -

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Thank you for completing this evaluation of Crisis Intervention Services. We appreciate your input.
Please mail your evaluation back to CIS at P.O. Box 1324; Cody, WY 82414. Attention: Executive Director Or fax to: 1-307-587-4353
Thank you! The staff of Crisis Intervention Services

1. In the last 12 months have you or your office/agency had contact with Crisis Intervention Services?
__yes __no If yes, at which Crisis Intervention Services office? __Cody __Powell

Please check all of the areas you or your office/agency had contact with Crisis Intervention Services.

__Protection Order assistance (Family Violence, Stalking, Sexual Assault)
__Emergency room advocacy __ Supervised Visitation/Custody Exchange program
__Public education presentation __CIS volunteer or agency training
__Crisis Hotline assistance __ Civil Standby with law enforcement
__Support group (___ adult group and/or ___ children's group)
__Other (please describe):

Did the CIS staff present themselves in a professional manner? __yes __no




2. Have you or your office made referrals to CIS in the last 12 months? __yes __no

3. On a scale from 1 to 5 with 1 being poor and 5 being excellent, how do you rate the overall services of CIS in the community? (Circle one): 1 2 3 4 5

4. Do you view CIS as the primary source of services and information on Domestic Violence and Sexual Assault in the Park County community? __yes __no

5. Did CIS provide an educational or awareness presentation to your office/agency? __yes __no
Who was the presenter? ______________________
Topic of presentation: _________________________
Comments on presentation materials, format, subject matter, etc:

6. Have you utilized the supervised visitation/exchange program at CIS? __yes __no
Comments on the visitation/exchange program, staff, visitation site:


7. Other comments on CIS services, staff, or programs:




Name: ______________________________________

Agency/Office Name:____________________________

Date: _______________________________________