Share Your Impact | Reentrybeyond

First name

Last name

Email

Phone

Briefly describe the service or support you received

What is your next step?

Anything else you want RR&B to know?

Client ID

If you have one — our staff can look it up or assign you one.

If Other, please describe

Did you get the help you needed?

Yes

Partially

No

Would you refer RR&B to someone else?

Yes

No

Maybe

If Other, please describe

If RR&B referred you to another organization, what happened?

I received a referral

I contacted the organization

An appointment or contact occurred

I received services from them

Not applicable — I wasn't referred

Which organization? (if referred)

May RR&B contact you about services and follow-ups?

May RR&B include your outcomes in anonymous reports?

May RR&B share your story publicly (testimonial/media)? This is separate from anonymous reporting — it means my name, photo, story, quote, or other identifying details could appear publicly. RR&B will always confirm with me first.