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* 1. Date of your appointment with Conciliation Court

Date

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* 2. I was treated in a courteous manner by Conciliation Court staff.

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* 3. FSCC Staff helped create a safe environment for discussion.

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* 4. I was given the opportunity to discuss my wishes and/or concerns regarding my case/family.

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* 5. Any other comments/concerns/suggestions

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* 6. (Optional) Please leave your contact information if you would be willing to be contacted in the future for a follow-up survey.

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