1. Completing this questionnaire will help us continue to provide high quality services.

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* 1. Demographics

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* 2. Ease of getting care

  Excellent Good Fair Poor N/A
Ability to get in to be seen
Prompt return of phone calls
The staff at LPA handles client matters in a professional and respectful manner
The staff at LPA attempt to be helpful and effective with questions or problems

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* 3. Treatment Outcomes

  Strongly Agree Agree Neutral Disagree Strongly Disagree
Our family felt supported and encouraged by our therapist
Our therapist understands my child's concerns and feelings
Skills that my child has learned in therapy are helping him/her make positive changes in his/her life
In our sessions, we were covering what was important to us
We are making a lot of progress on reaching our goals
Therapy is improving the quality of my child's life
Overall, therapy has been helpful for my child
I would recommend LPA to others who are seeking counseling services

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* 4. During this episode of treatment, my child has attended therapy and/or medication management at Lansing Psychological Associates:

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* 5. Which of the following best describes your child in the past week:

  Never Sometimes Often
Destroyed property
Was unhappy or sad
Behavior caused school problems
Had temper outbursts
Worrying prevented him/her from doing things
Felt worthless or inferior
Had trouble sleeping
Changed moods quickly
Used alcohol
Was restless, trouble staying seated
Engaged in repetitious behavior
Used drugs
Worried about most everything
Needed constant attention

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* 6. How much have your child's problems caused:

  Not at all A Little Somewhat A Lot
Interruption of personal time?
Disruption of family routines?
Any family member to suffer mental or physical problems?
Less attention paid to any family member?
Disruption or upset of relationships within the family?
Disruption or upset of your family's social activities?

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