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* 1. I am the:

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* 2. Parenting Time Center I use:

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

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* 4. Amount of time utilizing Parenting Time Center:

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

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

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


 Friendly:

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* 8. Helpful:

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* 9. Knowledgeable:

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* 10. Unbiased:

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* 11. Respectful:

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

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

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

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

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

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

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