Screen Reader Mode Icon Check SCREEN READER MODE to make this survey compatible with screen readers. Copy of Client Satisfaction Survey Family Counseling Services Question Title * 1. What services have you (or your child/children) received while at FCS? Check all that apply. Individual Counseling Marriage, Couples, and/or Family Counseling Play Therapy EMDR DD Behavior Intervention Other (please specify) OK Question Title * 2. Please check primary concerns that were discussed while receiving services at FCS. Suicidal thoughts Anger concerns Parenting Harm to self Harm to others Anxiety/Stress Relational concerns Life transitions Divorce Trauma/Abuse Depression/Saddness School/ Career Grief Community DD Program/ Behavior Intervention Court ordered Other (please specify) OK Question Title * 3. Please rate your current situation, compared to when you first started services at FCS. Somewhat worse No change Somewhat better Much better OK Question Title * 4. Please rate the following statements Strongly agree Somewhat agree Somewhat disagree Strong disagree NA Staff appeared friendly Staff appeared friendly Strongly agree Staff appeared friendly Somewhat agree Staff appeared friendly Somewhat disagree Staff appeared friendly Strong disagree Staff appeared friendly NA I felt I was treated with respect I felt I was treated with respect Strongly agree I felt I was treated with respect Somewhat agree I felt I was treated with respect Somewhat disagree I felt I was treated with respect Strong disagree I felt I was treated with respect NA The staff helped me feel comfortable with the services I/my family received The staff helped me feel comfortable with the services I/my family received Strongly agree The staff helped me feel comfortable with the services I/my family received Somewhat agree The staff helped me feel comfortable with the services I/my family received Somewhat disagree The staff helped me feel comfortable with the services I/my family received Strong disagree The staff helped me feel comfortable with the services I/my family received NA This program helped me This program helped me Strongly agree This program helped me Somewhat agree This program helped me Somewhat disagree This program helped me Strong disagree This program helped me NA I would recommend this agency to others I would recommend this agency to others Strongly agree I would recommend this agency to others Somewhat agree I would recommend this agency to others Somewhat disagree I would recommend this agency to others Strong disagree I would recommend this agency to others NA OK Question Title * 5. Overall, how satisfied were you with the services you have received at FCS? A great deal A lot A moderate amount A little None at all OK Question Title * 6. Do you currently have mental health/medical concerns that are not currently being addressed that you would like to discuss with a counselor from FCS? Yes No OK Question Title * 7. Contact Information: Name Company Address Address 2 City/Town State/Province ZIP/Postal Code Country Email Address Phone Number OK Question Title * 8. Comments regarding clients response to treatment OK Question Title * 9. Additional Comments OK DONE