OMB Control Number 0985-0065
Expiration Date: 1/31/2023
 
Please take a few minutes to answer all of the questions by marking the rating that best matches your opinion. Please choose only one answer per question. By submitting the form, you are agreeing to, or giving your consent, for your answers to become a part of our study. Your feedback will help us improve our work and will be kept completely private. 

The questions in this survey use the term “Adult Protective Services”. Adult Protective Services programs have different names in different areas. Please take a look at your paper copy of this survey for the specific name of the Adult Protective Services program that you worked with. 

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Question Title

* Please enter the form number listed on the bottom left corner of your Client Questionnaire. Be sure to include all 8 numbers and 2 dash marks. For example: 01-001-001

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