Client Feedback

Please assist us with obtaining feedback on the needs of our community!

This is an anonymous survey that will assist us with improving our scope of services.

Question Title

* 1. Which service type do you feel is helpful to your family? Please check all that apply.

Therapy/Counseling

Parenting Education

Assessment

Supervised Visitation

Transportation

Question Title

* 2. Do prefer in-home services where a Phoenix staff member comes to your home, or do you prefer to receive services elsewhere?

I prefer in-home services.

I prefer to meet in the community.

I prefer to meet at the Phoenix office.

Question Title

* 3. Do you have a reliable vehicle and funds to drive to and from an appointment?

Yes, I have reliable transportation

No, transportation is a barrier to services for me.

Question Title

* 4. Do you prefer to be seen by a female therapist or a male therapist?

Male therapist

Female therapist

No preference

Question Title

* 5. How old are you?

18-24

25-34

35-44

45-54

55-64

65+

Question Title

* 6. Which county do you reside?

Carroll County

Haralson/Polk County

Troup County

Other

Question Title

* 7. If you were required to pay out of pocket for therapy would you be able to afford the following:

$25 per hour

$35 per hour

$50 per hour

I would not be able to afford any of the above amounts.

Question Title

* 8. Optional: What gender do you identify as.

Male

Female

I do not wish to answer.

Question Title

* 9. Optional: What demographic do you identify with?

African American

Hispanic, Latino, or Spanish Origin

Asian

American Indian

White

Other; race not listed

I prefer not to answer