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Please help our agency make services better by answering some questions. Your answers are confidential and will not influence current or future services you receive. 

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* 1. In what program is your child receiving services? Check all that apply

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* 2. How long has your child been receiving services with this agency?

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* 3. Is your child discharging or will they continue with services?

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* 4. Race: How does your child identify?

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* 5. Gender: How does your child identify?

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* 6. What is your child's age?

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* 7. I am satisfied with the services that my child has received.

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* 8. If I had other choices, my child would still choose to get services from this agency.

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* 9. I would recommend this agency to a friend or family member.

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* 10. I and my child are treated with dignity and respect.

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* 11. Staff are sensitive to my family's cultural background (race, religion, language, etc.).

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* 12. I participated in the development of my child's treatment plan.

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