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

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

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

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

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

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* 9. Date of Visit (Optional):

Date / Time

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

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* 11. Additional Comments:

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* 12. Date of Survey (Optional):

Date / Time

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* 13. Contact Information (Optional):

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