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Surveys
2016
December
W
Week 12
Week 12
0%
Questions marked with a
*
are required
Exit Survey
How often do you attend counseling sessions at our agency?
Weekly
Monthly
Quarterly
Annually
Are you treated with respect by our office staff?
None of the time
Some of the time
Most of the time
All of the time
*
How long have you been receiving Court-ordered services?
*
What is the reason for your Court-ordered Therapy Sessions?
Child/Family Reunification
Psychiatric Evaluation (Voluntary or Involuntary)
Prison Release
Anger Management
Other
If Other Please Explain:
*
Are you Currently on Any Medications?
*
Has your mental health interfered with your normal social activities with family, friends, neighbors or groups?
Not At all
Slightly
Moderately
Quite A Bit
Almost all the time
*
Has your mental health interfered with your hobbies or recreational activities?
Not at All
Slightly
Moderately
Quite a Bit
Almost totally
Since attending our agency do you feel a effective change in your Mental Health?
Little to no change
Needs improvement
Well
Extremely Well
How satisfied are you with the following:
*
My Social Worker keeps information about me confidential
-
*
My Social Worker is honest and trustworthy
-
*
I would be completely happy to see this Social Worker again
-
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