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Client Satisfaction Survey

Thank you for taking the time to complete this confidential survey about your satisfaction with our services. We review this feedback every quarter and use it in our ongoing Performance and Quality Improvement process. Your feedback is very important to us!

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* 1. Please indicate which of the following you are:

Parent/Caregiver

Child Welfare Professional

Client

Other (please specify)

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* 2. What services have you received from our agency? Please select all that apply.

Counseling

Chosen Families Counseling

Psychiatric Services

CBHA

Post Adoption Linkage and Support (PALS)

Connecting Family Paths (Diversion Program)

Other (please specify)

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* 3. Name of the staff member you worked with from our agency:

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* 4. Are/were you satisfied with the services you/your child and family received?

Yes

Comments:

Client Satisfaction Survey

Question Title

* 1. Please indicate which of the following you are:

Question Title

* 2. What services have you received from our agency? Please select all that apply.

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* 3. Name of the staff member you worked with from our agency:

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* 4. Are/were you satisfied with the services you/your child and family received?

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* 5. If no, please give us additional feedback:

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* 6. Please list our strengths compared to other agencies you have worked with:

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* 7. Please give us suggestions to improve our services, communications, and/or community partnerships:

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* 8. If you would like us to contact you directly regarding your feedback, please list your name and contact information: