Client Satisfaction Survey – Crisis Services
Please take a moment to complete this client satisfaction survey regarding our Crisis Services, thank you!
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1.
Date
(Required.)
2.
Your Name: (Optional)
*
3.
Crisis Staff’s Name(s):
(Required.)
*
4.
Location you (or your child) received crisis services:
(Required.)
*
5.
Please rate the Crisis Staff’s ability to: Understand your (or your child’s) main concerns
(Required.)
Excellent
Very Good
Good
Fair
Poor
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6.
Please rate the Crisis Staff’s ability to: Explain what SASS is and ‘what’s next’ for your (or your child’s) treatment
(Required.)
Excellent
Very Good
Good
Fair
Poor
*
7.
Please rate the Crisis Staff’s attention to: positive supports (such as family members, friends, activities etc.) to you (or your child) when creating the safety plan
(Required.)
Excellent
Very Good
Good
Fair
Poor
*
8.
I (and/or my child) were treated with respect throughout the assessment.
(Required.)
True
False
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9.
I (and/or my child) were treated with respect during aftercare and follow-ups from SASS.
(Required.)
Very Often
Occasionally
Sometimes
Rarely
Never
*
10.
How likely are you to recommend FSA to others?
(Required.)
Very likely
Likely
Neutral
Unlikely
Very unlikely
11.
Please provide any additional suggestions or comments regarding your overall experience with FSA:
