FCIU Client Satisfaction Survey

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Please correct the field(s) marked in red below:

Name (optional):

Therapist (optional): 

(Select one):
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(Select one):

I. First Impressions

How did you hear about the Family Crisis Intervention Unit (FCIU)? 
Did you come to the FCIU voluntarily?
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Did you come to the FCIU voluntarily?
The convenience of the location of the office: 
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The convenience of the location of the office:

The comfort of the office atmosphere:

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The comfort of the office atmosphere:
The availability of appointment times:
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The availability of appointment times:

II. Your Treatment 

Please Indicate:

The reason your family sought services at the FCIU (check all that apply):
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The reason your family sought services at the FCIU (check all that apply):

How many sessions have you and/or your family attended at the FCIU:

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How many sessions have you and/or your family attended at the FCIU:
The severity of your family issues at the start of treatment on a scale of 1 to 5 (1=minimal, 5=maximum)
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The severity of your family issues at this point in treatment on a scale of 1 to 5 (1=minimal, 5=maximum)
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Your satisfaction with the process of how you and your therapist established your family service plan:
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Your satisfaction with the process of how you and your therapist established your family service plan:
Your overall satisfaction with the treatment:
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Your overall satisfaction with the treatment:

How well the FCIU staff worked with your other providers regarding your family’s needs:

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How well the FCIU staff worked with your other providers regarding your family’s needs:

III. Staff

Please Indicate:

The professionalism, knowledge, and courtesy of the staff (from your reception to treatment):

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The professionalism, knowledge, and courtesy of the staff (from your reception to treatment):

Your therapist’s level of:

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Your therapist’s level of:
Poor Fair Good Very Good Excellent
Professionalism
Knowledge
Courtesy

The attention to your privacy and the way our policies were explained to you:

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The attention to your privacy and the way our policies were explained to you:

The attention given to your issues and concerns:

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The attention given to your issues and concerns:

IV. Interpreter Services (if applicable)

Please Indicate:

The degree of professionalism of your interpreter:

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The degree of professionalism of your interpreter:

The overall quality of your interpretation services:

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The overall quality of your interpretation services:

Please feel free to comment further on any aspect of your involvement with the FCIU:

Your comments are invaluable!

Thank you for your participation!

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