* 1. I am the:

* 2. Parenting Time Center I use:

* 3. Service I have used at the Parenting Time Center

* 4. Amount of time utilizing Parenting Time Center:

* 5. Parenting Time has benefited me in the following ways (please check all that apply):

* 6. Parenting Time Center has benefited my child(ren) the following ways (please check all that apply)

* 7. Please rate Parenting Time Center on the following:


 Friendly:

* 8. Helpful:

* 9. Knowledgeable:

* 10. Unbiased:

* 11. Respectful:

* 12. What did you find most helpful about the services you and your child(ren) received:

* 13. Is there additional information that you or your child(ren) would have liked to receive?

* 14. Are there additional services that you or your child(ren) would have liked to receive?

* 15. How would you improve the services that you or your child(ren) received?

* 16. If Someplace Safe had $100,000 what would you recommend is done with the money?

* 17. Please share with us any other comments you have about your experiences at the Parenting Time Center:

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