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THE ARC NORTHERN CHESAPEAKE REGION SURVEY OF FAMILY/CAREGIVER SATISFACTION WITH FAMILY SUPPORT SERVICES
This survey is intended to provide our agency with information about the quality of services provided by Family Support Services. Please read each item carefully and check the box that most accurately represents your level of satisfaction with the service you have received.

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* 1. How would you rate the amount of activities offered during the past year?

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* 2. How would you rate the knowledge and impact on your family that you obtained from trainings and workshops through the FSS department?

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* 3. How would you rate the support you received from FSS staff that enabled your family to participate in community life?

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* 4. How would you rate the nature and extent to which you and your family were actively involved in deciding what types of services/supports that you received?

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* 5. How would you rate the quality of help and guidance you received from the FSS staff?

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* 6. How would you rate the respect shown to you and your family member by the FSS staff?

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* 7. How would you rate the responsiveness of the FSS staff to your calls, concerns, and requests for information?

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* 8. How would you rate the support you received from FSS staff in working with others associated with your child (school, community resources, other agencies, etc.)?

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* 9. How would you rate the effecdtiveness of the respite care program in providing a "health time out" for you and your family?

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* 10. How would you rate the impact of Family Support Services to reduce the amount of stress in your life?

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* 11. How would you rate the assistance, information, and knowledge that was provided by the FSS staff that was used to make choices and decisions for you and your family?

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* 12. How would you rate the overall services that you and your family received from the FSS staff?

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* 13. FSS Services Utilized: (Please choose all services utilized)

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* 14. Additional comments:

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* 15. Name and phone number (optional):

THANK YOU FOR YOUR TIME AND YOUR FEEDBACK!

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