Feedback Surveys

We currently have two distinct feedback forms. Please select one of the following:
 
Family / Client Feedback Form
Referring Agent/Ongoing Team Member
PLEASE ANSWER ALL QUESTIONS IN RED.

We want to hear from you! This survey will only take a few minutes to complete. We would like to thank you in advance for any feedback you can give about your experience with Foundations Counseling Center.
 
Child's Name:
In-Home Team:
County/Social Worker:
1.
Was the intake and treatment plan meeting scheduled in a timely manner?		Yes       No   
2.
Was your input asked for and used in developing goals?		Yes       No   
3.
Do you feel our staff developed appropriate goals for your family? 		Yes       No   

Comments:
4.
In your opinion, did Foundations Counseling Center's In-Home team develop a helping relationship with your child and your family?		Yes       No   
5.
Did the team present in a professional manner?		Yes       No   
6.
Did the team follow through with helping you reach your stated goals?		Yes       No   
7.
Was the team knowledgeable and helpful?		Yes       No   
8.
Do you feel that the time allowed for appointments was enough to meet your needs?		Yes       No   
9.
Were our training/educational materials helpful?		Yes       No   

Comments:
Please rate improvement in the following areas using the 1-5 scale provided below. 1 being little to no progress and 5 being total achievement.
 
 
1 2 3 4 5
10.
Positive Family Interactions:
11.
Positive Parenting:
12.
School:
13.
Reduced Acting Out:
14.
Public Behavior:
15.
Following Directions:
16.
Anger Management/Aggression:
17.
Appropriate Sexual Behavior:
18.
Alcohol and Drug Use:

Additional Comments:

                 
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