Our Family Services Client Satisfaction

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* 1. Which service have you received from us?

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* 2. Age?

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* 3. Gender?

Male

Female

Other (please specify)

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* 4. Ethnicity?

Hispanic or Latino

Not Hispanic or Latino

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* 5. Race?

Caucasian (white)

African American (black)

Native American

Asian

Hawaiian/Pacific Islander

Mixed Race

Other (please specify)