* 1. It is easy to get in contact with the Visitation Center.

* 2. The Visitation Center Staff gets back to me in a timely manner.

* 3. The Visitation Center listens to what I say.

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

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

* 6. Visitation Center Staff provides me helpful feedback about my visit with my child (ren).

* 7. The facilities/activities at the Visitation Center meet my family's needs.

* 8. I feel that myself and my child (ren) are safe while at the Visitation Center.

* 9. Date of Visit (Optional):

Date / Time

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

* 11. Additional Comments:

* 12. Date of Survey (Optional):

Date / Time

* 13. Contact Information (Optional):