Foundations Counseling Center LLC

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: County/Social Worker:

1. Was Foundations Counseling Center's referral process timely?	Yes No
2. Was the referral process convenient for you?	Yes No
3. Was the referral handled professionally by our staff?	Yes No
Comments:

4. Was the intake and treatment plan meeting scheduled in a timely manner?	Yes No
5. Was your input and recommendations used in developing treatment goals?	Yes No
6. Do you feel our staff developed appropriate treatment goals for the family?	Yes No
Comments:

7. Were Foundations Counseling Center reports sent to you in a timely manner?	Yes No
8. Were reports substantive?	Yes No
9. Were reports helpful to you?	Yes No
Comments:

10. In your opinion did Foundations Counseling Center's In-Home team develop a therapeutic relationship with the child and their family?	Yes No
11. Did the team present in a professional, competent manner?	Yes No
12. Did the team follow through with stated goals and objectives?	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
13. Improvement on the identified primary treatment issues
14. Improvement on the identified secondary treatment issues
15. Improvement in school functioning
16. Improvement in overall mental health
17. Improvement in overall family functioning
18. Rate your overall satisfaction with our services
Additional Comments: