BTSS Customer Feedback
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To help us respond to any difficulties or requests you might make on this survey, AND so that we can send you a little thank you surprise gift, you MAY complete the following. If you would like to make anonymous comments, you may leave this blank. Name:
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	MM		DD		YYYY
Initial appointment date	When were you receiving a service or when did you request information from BTSS? Initial appointment date Month	/	Day	/	Year
Final appointment date	Final appointment date Month	/	Day	/	Year

What was the MAIN reason for your appointment with BTSS? Solution Focused Brief Therapy

Autism Diagnostic Interview

Social Skills Course

Life Skills Course

Staff Training in Autism

Staff Training in Solution Focused Approaches

Support within the Criminal Justice System

Tuesday Evening Social Club

Other

Other (please specify)

	Not at all	Somewhat	Quite	Extremely	N/A
Initial telephone contact	*How happy were you with your initial contact with BTSS? Initial telephone contact Not at all	Initial telephone contact Somewhat	Initial telephone contact Quite	Initial telephone contact Extremely	Initial telephone contact N/A
Initial E-mail contace	Initial E-mail contace Not at all	Initial E-mail contace Somewhat	Initial E-mail contace Quite	Initial E-mail contace Extremely	Initial E-mail contace N/A
Website browsing	Website browsing Not at all	Website browsing Somewhat	Website browsing Quite	Website browsing Extremely	Website browsing N/A
Initial face to face meeting	Initial face to face meeting Not at all	Initial face to face meeting Somewhat	Initial face to face meeting Quite	Initial face to face meeting Extremely	Initial face to face meeting N/A

Other (please specify)

	Not at all	Somewhat	Quite	Extremely	N/A
Face to face appointment	*Overall, how pleased were you with the service you received? Face to face appointment Not at all	Face to face appointment Somewhat	Face to face appointment Quite	Face to face appointment Extremely	Face to face appointment N/A
Written dagnostic rport	Written dagnostic rport Not at all	Written dagnostic rport Somewhat	Written dagnostic rport Quite	Written dagnostic rport Extremely	Written dagnostic rport N/A
Written ltter	Written ltter Not at all	Written ltter Somewhat	Written ltter Quite	Written ltter Extremely	Written ltter N/A
Vicky's attendance at meetings	Vicky's attendance at meetings Not at all	Vicky's attendance at meetings Somewhat	Vicky's attendance at meetings Quite	Vicky's attendance at meetings Extremely	Vicky's attendance at meetings N/A
Other	Other Not at all	Other Somewhat	Other Quite	Other Extremely	Other N/A

Other (please specify)

	Not at All	Somewhat	Quite	Extremely	N/A
Getting a diagnosis	*How helpful was Vicky in assisting you to get what you needed from the BTSS? Getting a diagnosis Not at All	Getting a diagnosis Somewhat	Getting a diagnosis Quite	Getting a diagnosis Extremely	Getting a diagnosis N/A
Meeting therapy aims	Meeting therapy aims Not at All	Meeting therapy aims Somewhat	Meeting therapy aims Quite	Meeting therapy aims Extremely	Meeting therapy aims N/A
Booking on a course	Booking on a course Not at All	Booking on a course Somewhat	Booking on a course Quite	Booking on a course Extremely	Booking on a course N/A
Commissioning a course	Commissioning a course Not at All	Commissioning a course Somewhat	Commissioning a course Quite	Commissioning a course Extremely	Commissioning a course N/A
Receiving general information	Receiving general information Not at All	Receiving general information Somewhat	Receiving general information Quite	Receiving general information Extremely	Receiving general information N/A
Help within the criminal justice system	Help within the criminal justice system Not at All	Help within the criminal justice system Somewhat	Help within the criminal justice system Quite	Help within the criminal justice system Extremely	Help within the criminal justice system N/A

Other (please specify)

	Not at all	Somewhat	Very	Extremely	N/A
A diagnostic interview	*How likely are you to recommend the BTSS to other people for: A diagnostic interview Not at all	A diagnostic interview Somewhat	A diagnostic interview Very	A diagnostic interview Extremely	A diagnostic interview N/A
Solution Focused Therapy	Solution Focused Therapy Not at all	Solution Focused Therapy Somewhat	Solution Focused Therapy Very	Solution Focused Therapy Extremely	Solution Focused Therapy N/A
Going on a course	Going on a course Not at all	Going on a course Somewhat	Going on a course Very	Going on a course Extremely	Going on a course N/A
Commissioning a course	Commissioning a course Not at all	Commissioning a course Somewhat	Commissioning a course Very	Commissioning a course Extremely	Commissioning a course N/A
Helping with the criminal justice system	Helping with the criminal justice system Not at all	Helping with the criminal justice system Somewhat	Helping with the criminal justice system Very	Helping with the criminal justice system Extremely	Helping with the criminal justice system N/A

Other (please specify)

What was the best thing about Vicky's involvement?

What would make the service a little bit better?

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