Good Samaritan Advocates

Client Survey

 

Thank you for visiting your local GSA clinic.

We appreciate your feedback. Please take the time to fill out the form below to let us know how we are doing and how we can better serve you and your neighbors in the future. 

When you submit this form it is sent to our main office in Springfield, VA. Your answers will not be shared with the attorneys who helped you, and your comments will only be made public with your permission. Thank you for your time and input. 

 
Date of Clinic *
Date of Clinic
Who are the attorney(s) who assisted you today?
Who are the attorney(s) who assisted you today?
Are you willing to have a GSA volunteer contact you so you can share your experience and any feedback that may help us improve the GSA program?
If yes, please provide your name and contact information
If yes, please provide your name and contact information