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* 1. Completed by

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* 2. Program

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* 3. The school district I attend is:

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* 4. I receive my services at

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* 5. I am currently in grade:

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* 6. I enjoy going/participating in services

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* 7. My Mental Health Worker answers any questions I may have

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* 8. My Mental Health Worker lets me choose some activities during our sessions

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* 9. I help my Mental Health Worker decide on goals to work on

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* 10. My Mental Health Worker explains why we are doing something

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* 11. I participate to the best of my ability

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* 12. My Mental Health services have helped me improve: (select all that apply)

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* 13. What do you wish was different with your Mental Health services?

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