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* 1. It is easy to get in contact with Family & Children Services.

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* 2. Family & Children Services Staff gets back to me in a timely manner.

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* 3. Family & Children Services listens to what I say.

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* 4. I understand the actions taken on my case.

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* 5. Overall I feel that I was treated professionally and respectfully.

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* 6. Date of Visit (Optional):

Date / Time

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* 7. Name of Staff Member I met with or talked to:

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* 8. Additional Comments:

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* 9. Date of Survey (Optional):

Date / Time

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* 10. Contact Information (Optional):

T