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  2. 2014
  3. June
  4. T
  5. TVRS Client Servises
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Questions marked with an * are required Exit Survey
 
 
* Your Name:
 
 
 
* Client Name:
 
 
 
* Service Provided:
 
Risk Reduction and/or Resiliency Strength Assessment and Counseling
 
Psychosocial Counseling
 
Substance Abuse Counseling
 
Mentoring (peer or other)
 
Case Management Services
 
Career Counseling / Job Training
 
Life Skills
 
Parenting Skills
 
Crisis Counseling
 
Legal Assistance
 
Mental Health Counseling
 
English Language Skills Assistance
 
Family Counseling
 
Other Services
 
 
 
If you answered other, please describe the service provided
   
 
 
 
* Who received the service? (One or more)
 
Client
 
Partner/Spouse
 
Child
 
Sibling
 
Parent
 
Extended Family

 
 
 
* How was this service provided?
 
Phone
 
In-Person
 
Group Format
 
Electronically
 
 
 
Total Time Providing Services (Hours, Minutes)
Hours
Minutes
 
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