2013 Client Satisfaction Survey
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1. CCCCF Client Satisfaction Survey

1. What services does CCCCF provide to you? (Check all that apply)

What services does CCCCF provide to you? (Check all that apply) Mental Health Therapy (Individual, Family or Couples)

Parent Education Course

Anger Management Course

Substance Abuse

Impulse Control Course

Mental Health Assessment

Comprehensive Behavioral Health Assessment

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2. How often does the person from CCCCF see you?

How often does the person from CCCCF see you? Once a week	Once every two weeks	Once a month	Other
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3. How long does your session typically last?

How long does your session typically last? 1 hour	2 hours	4 hours	Other
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4. Where do your sessions take place?

Where do your sessions take place? Home	Juvenile Assessment Center (JAC)	School	Day Care	Place of Employment	Shelter	Visitation Center	Other
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5. How would rate the quality of the clinical service(s) provided to you?

How would rate the quality of the clinical service(s) provided to you? Excellent	Good	Average	Fair	Poor	Other
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6. Did your therapist keep appointments with you as scheduled?

Did your therapist keep appointments with you as scheduled? Yes	No	Sometimes	Other
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7. Did your therapist communicate with you well and return calls in a timely manner?

Did your therapist communicate with you well and return calls in a timely manner? Yes	No	Sometimes	Other
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8. Did your therapist act professional at all times and keep all information confidential unless you gave permission for them to speak with someone?

Did your therapist act professional at all times and keep all information confidential unless you gave permission for them to speak with someone? Yes	No	Sometimes	Other
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9. How would you rate our overall services provided to you?

	Excellent	Good	Fair	Poor
Service	*How would you rate our overall services provided to you? Service Excellent	Service Good	Service Fair	Service Poor
Professionalism	Professionalism Excellent	Professionalism Good	Professionalism Fair	Professionalism Poor
Cost	Cost Excellent	Cost Good	Cost Fair	Cost Poor
Ease of Scheduling	Ease of Scheduling Excellent	Ease of Scheduling Good	Ease of Scheduling Fair	Ease of Scheduling Poor

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10. Would you recommend CCCCF to someone else?

Would you recommend CCCCF to someone else? Yes	No	Maybe	Other
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