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FCIU Client Satisfaction Survey
FCIU Unidad de Intervencion en Crisis Familiares Estudio de Satisfaccion al Cliente
FCIU Client Termination Satisfaction Survey
FCIU Unidad de Intervencion en Crisis Familiares Estudio de Satisfaccion al Cliente (Terminacion)
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Family Crisis Intervention Unit
FCIU Client Termination Satisfaction Survey
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Please correct the fields below:
Please correct the field(s) marked in red below:
Thank you for taking the time to complete this survey. Your participation helps us to better serve you. Please be assured that your responses are anonymous.
Who initiated plans to proceed with terminating FCIU services?
*
Who initiated plans to proceed with terminating FCIU services?
Therapist
Self
Both
Please indicate the severity of your family issues at the start of your treatment on a scale of 1 to 5 (1=minimal, 5=maximum)
*
Please indicate the severity of your family issues at the start of your treatment on a scale of 1 to 5 (1=minimal, 5=maximum)
(Select an Answer)
1
2
3
4
5
Please indicate the severity of your family issues at the conclusionof your treatment on a scale of 1 to 5 (1=minimal, 5=maximum)
*
Please indicate the severity of your family issues at the conclusionof your treatment on a scale of 1 to 5 (1=minimal, 5=maximum)
(Select an Answer)
1
2
3
4
5
Your status at closing (check all that apply)
Your status at closing (check all that apply)
Service goals were met
Referred for long term and/or specialized services
Moved out of the county
Declined further services
Dissatisfaction with services
Other (please specify)
If other, type text here.
Your satisfaction with the plan at the conclusion of your treatment
*
Your satisfaction with the plan at the conclusion of your treatment
Poor
Fair
Good
Very Good
Excellent
Your satisfaction with the quality of treatment at the FCIU
*
Your satisfaction with the quality of treatment at the FCIU
Poor
Fair
Good
Very Good
Excellent
The likelihood that, if necessary, you would seek assistance from the FCIU in the future
*
The likelihood that, if necessary, you would seek assistance from the FCIU in the future
Poor
Fair
Good
Very Good
Excellent
Please feel free to comment further on any aspect of your involvement with the FCIU
Please feel free to comment further on any aspect of your involvement with the FCIU
To receive a copy of your submission, please fill out your email address below and submit.
Email Address
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