We’re here to help

416-927-8900

Please fill out the following form to assist us in understanding the needs of our clients and to help us serve you better. Sheena’s Place respects your privacy, protects your personal information, and does not disclose, sell, trade nor lend our mailing list. The information on this form is used for statistical and planning purposes only. All personal information is securely stored using participant confidentiality codes and without identifying information. If you have any questions regarding how we gather, use or retain personal information, please ask to speak with Sara Robb, our Manager of Outreach and Research.

 

Participant Confidentiality Code

In order to ensure your confidentiality and protect your identity, a ‘personal confidentiality code’ is used for all participants. The code will be used each time you fill out an information form or service evaluation.

Here’s an example of what a confidentiality code looks like:

If your mother’s name is/was Mary

The first two letters will be

MA

If your birth year is 1982

Your response will be

82

If your ‘father’s’ name is/was Anthony

The first two letters will be

AN

Participant Code

 

MA 82 AN

 

Note: ‘Mother’ and ‘father’ are used as general terms and refer to whomever you identify as your key parenting figures (includes kin, foster, adoptive, sibling, special friend or other forms of a parent figure) regardless if it is a ‘mother’/‘father’ union, a ‘mother’/‘mother’ union, or a ‘father’/‘father’ union.

GENERAL INFORMATION

OVERALL SATISFACTION WITH THIS GROUP

Please select the level of agreement that best reflects your experience with Sheena’s Place Groups

OVERALL SATISFACTION WITH SHEENA’S PLACE

Please select all statements below that are true for you

I PARTICIPATE AT SHEENA'S PLACE BECAUSE:

Please select the level of agreement that best reflects your motivations for coming to Sheena’s Place