DFCS Satisfaction Survey Question Title * 1. Provider began working with us within the first 2 buisness days of initial contact 0=N/A 1=Strongly Disagree 2=Disagree 3=Agree 4=Strongly Agree 0=N/A 1=Strongly Disagree 2=Disagree 3=Agree 4=Strongly Agree Question Title * 2. Provider considered my family's strenghth and opinions 0=N/A 1=Strongly Disagree 2=Disagree 3=Agree 4=Strongly Agree Question Title * 3. Provider considered my family's schedule when making appointments 0=N/A 1=Strongly Disagree 2=Disagree 3=Agree 4=Strongly Agree Question Title * 4. The time spent with my family before the Famly Team meeting (FTM) was helpful in preparing for the meeting 0=N/A 1=Strongly Disagree 2=Disagree 3=Agree 4=Strongly Agree Question Title * 5. Provider was courteous and respectful 0=N/A 1=Strongly Disagree 2=Disagree 3=Agree 4=Strongly Agree Question Title * 6. Provider kept appointments and was on time 0=N/A 1=Strongly Disagree 2=Disagree 3=Agree 4=Strongly Agree Question Title * 7. Provider contacted me within 24 hours before appointments to alert me to schedule changes and attempted to reschedule appointments at a time that was convenient for my family 0=N/A 1=Strongly Disagree 2=Disagree 3=Agree 4=Strongly Agree Question Title * 8. Provider worked with my family in crisis and was helpful calming the situation 0=N/A 1=Strongly Disagree 2=Disagree 3=Agree 4=Strongly Agree Question Title * 9. Transportation services were dependable and on time 0=N/A 1=Strongly Disagree 2=Disagree 3=Agree 4=Strongly Agree Question Title * 10. The materials and skills shared were helpful to achieve my case plan 0=N/A 1=Strongly Disagree 2=Disagree 3=Agree 4=Strongly Agree Question Title * 11. I feel the provider communicated my family's strengths and needs clearly to DFCS 0=N/A 1=Strongly Disagree 2=Disagree 3=Agree 4=Strongly Agree Question Title * 12. I have gained knowledge and or/skills by participating in this program 0=N/A 1=Strongly Disagree 2=Disagree 3=Agree 4=Strongly Agree Question Title * 13. Provider gave me a name of a contact person to express my concerns and/or issues with their customer service 0=N/A 1=Strongly Disagree 2=Disagree 3=Agree 4=Strongly Agree Question Title * 14. What are the skills you learned form this program that are useful to you? Question Title * 15. How will you apply the skills you learned in this program? Question Title * 16. What are some skills you currently use that will be discontinued as a result of participating in this program? Question Title * 17. What changes or suggestions would you recommend regarding this program? Question Title * 18. Additional Comments Question Title * 19. Agency/Client information Agency Name Service Provided: Family Name: Service Start Date (MM/YY): Service End Date *=(MM/YY): Today's Date: Done