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Client Satisfaction Survey
www.familiesfirstfl.com
1.
What services do you receive at Families First of Florida?
Individual/Family counseling
Targeted Case Management
In-Home Parenting
Psychiatry
Substance Abuse treatment
Other (please specify)
2.
Services are currently open.
Yes, I am currently receiving services
No, I have been discharged from services
3.
Which location do you receive your services from?
Tampa
Lakeland
Orlando
Ocala
Tallahassee
Panama City
4.
How are you related to the client?
I am the client.
I am the parent of the client.
I am the legal guardian of the client.
I am the client's case manager.
I am the foster parent/caregiver for the client.
Other (please specify)
5.
The gender of the person receiving services:
Male
Female
N/A I would prefer not to answer
6.
The age group of person receiving services is:
12 years old or younger
Over 12 years old but younger than 18 year old.
Over 18 years old but younger than 22 years old.
Over 22 years old.
N/A I would prefer not to answer
7.
How long have services been received from Families First of Florida?
less than 6 months.
6-12 months.
more than 12 months.
Other (please specify)
8.
Making the initial intake appointment was easy and scheduled timely.
Yes
Partially (either easy or timely but not both)
No
Don't know
Please explain your answer.
*
9.
Overall, what is your satisfaction with the services you received?
(Required.)
Extremely satisfied
Moderately satisfied
Slightly satisfied
Neither satisfied nor dissatisfied
Slightly dissatisfied
Moderately dissatisfied
Extremely dissatisfied
Please explain your answer.
10.
Overall, how convenient was it for you to use Families First of Florida's services?
Extremely convenient
Very convenient
Moderately convenient
Slightly convenient
Not at all convenient
Please explain your score.
11.
I would recommend Families First of Floirda
Yes - definitely!
Most Likely
Not Sure either way
Probably not
No - definitely not!
Please explain
12.
I feel like the services provided by Families First of Florida have helped me.
Greatly Agree
Agree
Neither Agree nor Disagree
Disagree
Greatly Disagree
Greatly Agree
Agree
Neither Agree nor Disagree
Disagree
Greatly Disagree
Please explain.
13.
Please share the name of your service provider (i.e. therapist, psychiatrist etc.)
14.
What else do you want us to know?
15.
Please complete the following if we can contact you:
Name:
Phone:
Email:
