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Community Partners for Child Safety Satisfaction Survey v2

Help Us Improve

Your feedback helps Ireland Home Based Services know what we're doing well and where we need to grow.  Your honesty is appreciated.  Thank you for your time!
1.My IHBS Service Provider (First and Last Name)(Required.)
2.Case Number(Required.)
3.Opinion(Required.)
Strongly Disagree (1)
Disagree (2)
Neutral (3)
Agree (4)
Strongly Agree (5)
The Community Partners program helped me and my family.
 My Community Partners provider treated me with courtesy/respect.
Services were available to my family when we needed them.
 My Community Partners provider worked with us to accomplish our goals.
 My Community Partners provider was respectful of differences in race, culture, sex, religion, etc.
I was made aware of my family’s rights and the agency’s grievance process on my first visit/intake appointment.
Meetings with my Community Partners provider were scheduled in a timely manner and at a frequency that met my family’s needs.
 My privacy was respected by my Community Partners provider.
Overall, I was pleased with the Community Partners program.
I would recommend the Community Partners for Child Safety Program to others.
4.Comments(Required.)
5.My Community Partners Services Provider sees me:(Required.)
6.The last time I saw my Ireland Home Based Services Provider was(Required.)
Date / Time
Time
:
Thank you for taking the time to complete this survey!