General Client Survey for Website Question Title * 1. Date of your appointment with Conciliation Court Date / Time Date Question Title * 2. I was treated in a courteous manner by Conciliation Court staff. Strongly Disagree Disagree Neutral Agree Strongly Agree Strongly Disagree Disagree Neutral Agree Strongly Agree Other (please specify) Question Title * 3. FSCC Staff helped create a safe environment for discussion. Strongly Disagree Disagree Neutral Agree Strongly Agree Strongly Disagree Disagree Neutral Agree Strongly Agree Other (please specify) Question Title * 4. I was given the opportunity to discuss my wishes and/or concerns regarding my case/family. Strongly Disagree Disagree Neutral Agree Strongly Agree Strongly Disagree Disagree Neutral Agree Strongly Agree Other (please specify) Question Title * 5. Any other comments/concerns/suggestions Question Title * 6. (Optional) Please leave your contact information if you would be willing to be contacted in the future for a follow-up survey. Name Email Address Phone Number Done