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154 Cannifton Road North, Belleville, K8N 4Z6

Home
About Us
Resources
Services
Treatments
Contact Us
- Get In Touch
- Client Feedback

154 Cannifton Road North, Belleville, K8N 4Z6613 689 7783

Police Services Member Survey

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Police Services Member Survey

Service Status(Required)

Are You:- A current or former member of the Belleville Police Service?

Are You:- A spouse or family member of a current or former Belleville Police Service member?

Would you be interested in attending a support group for Belleville Police Service members?(Required)

Yes

No

Would you be interested in attending a support group for spouses and family members of Belleville Police Service members?(Required)

Yes

No

Do you have any concerns about attending a group?(Required)

Yes

No

Would you like to be contacted to discuss your concerns?(Required)

Yes

No

Name(Required)

First Last

Phone(Required)

Email(Required)

Belleville Police Services Member Survey

If you were to attend a group, which format would you prefer?(Required)

In Person

Online (via zoom)

I am open to both in person or online

What day of the week would be best for you to attend a group? (select all that apply)(Required)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

What time would be best for you to attend a support group? (select all that apply)(Required)

8.30AM

4.00PM

7.00PM

Other

Please Specify(Required)

How frequently would you wish to attend a group?

Once a week

Once every 2 weeks

Once a month

Other

Please Specify(Required)

What are some topics or themes you would like to explore in a support group as a Belleville Police Service Member? (select all that apply)(Required)

a space to share and listen to others with similar experiences

understanding and dealing with traumatic experiences for self or others

information on managing low mood, anxiety or anger difficulties

information and management of sleep difficulties

mindfulness and relaxation techniques

Other

Please Specify(Required)

Do you have any concerns about taking part in a support group with other Belleville Police Service Members?

Yes

No

Please add your concerns(Required)

Do you have any additional comments or questions?(Required)

Yes

No

Enter additional comments or questions(Required)

Do you wish to be contacted about the support group we will be running?(Required)

Yes

No

Name(Required)

First Last

Email(Required)

Phone(Required)

Belleville Police Services Spouse and Family Members Survey

If you were to attend a group, which format would you prefer?(Required)

In Person

Online (via zoom)

I am open to both in person or online

What day of the week would be best for you to attend a group? (select all that apply)(Required)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

What time would be best for you to attend a support group? (select all that apply)(Required)

8.30AM

4.00PM

7.00PM

Other

Please Specify(Required)

How frequently would you wish to attend a group?

Once a week

Once every 2 weeks

Once a month

Other

Please Specify(Required)

What are some topics or themes you would like to explore in a support group? (select all that apply)(Required)

A space to share and listen to others with similar experiences

Understanding and dealing with traumatic experiences for self or others

Information on managing low mood, anxiety or anger difficulties

Information and management of sleep difficulties

Mindfulness and relaxation techniques

Other

Please Specify(Required)

Do you have any concerns about taking part in a support group with other spouses or family members of Belleville Police Service members?(Required)

Yes

No

Please add your concerns(Required)

Do you have any additional comments or questions?(Required)

Yes

No

Enter additional comments or questions(Required)

Do you wish to be contacted about the support group we will be running?(Required)

Yes

No

Name(Required)

First Last

Email(Required)

Phone(Required)

Thank You

Your Response Has Been Received.

As requested, you will not be contacted for any follow up

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Address:
154 Cannifton Road North, Belleville, K8N 4Z6
Phone:
613 689 7783
Fax:
613 689 7363
Email:

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