FASD Assessment Services - Post Clinic Client Survey 

You recently participated in an FASD assessment at our clinic. Your feedback will help us evaluate and improve our services. Thank you for taking the time to complete this survey. Your responses are entirely voluntary, and you may refuse to complete any part or all of this survey.  Please answer openly and honestly. 

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* 1. Please enter the date (or approximate date) your assessment was completed.

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* 2. Your age:

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* 3. What gender do you identify as?

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* 4. Was the clinic process explained to you?

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* 5. Do you understand your diagnosis?

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* 6. Do you have an increased understanding of how FASD affects you?

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* 7. Are you more aware of your needs and strengths?

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* 8. Do you have an increased understanding of the resources and services available in your community?

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* 9. Were you treated respectfully by the clinic staff?

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* 10. I require further assistance in the following areas (click all that apply).

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* 11. Do you have other comments or suggestions? If yes, please explain.

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