Exit Survey

First name

Last name

I feel my communication with my family is

I DON'T get along with my family and have a lot of conflict. This has a PROFOUND NEGATIVE impact on my daily life

I have SOME DIFFICULTY getting along with my family. This has a NEGATIVE impact on my daily life

SOMETIMES I don't get along with or communicate well with my family but this is IMPROVING

I GET ALONG and communicate well with my family. I have difficulties ONLY OCCASIONALLY

I GET ALONG and communicate very well with my family and this has POSITIVE IMPACTS on my daily life

How I feel about engaging in services

I have A LOT OF DIFFICULTY engaging and working with services to help me improve my cirucmstances

I have SOME DIFFICULTY engaging and working with services to help me improve my circumstances

I OCCASSIONALLY have difficulty engaging and working with services to help me improve my circumstances

I SELDOM have difficulty engaging and working with services to help me improve my circumstances

it is EASY to work with services to help me improve my circumstances. I RARELY have difficulties

How do you feel the service listened to you

The service DOES NOT listen or understand my issues at all

The service listens a LITTLE BIT or understands SOME of my issues

The service SOMETIMES listens or understands my issues

The service listens to me and understands my issues A LOT of the time

The service ALWAYS listens to me and understands my issues

How satisfied are you of the service

I am NOT satisfied

I am a LITTLE satisfied

The service was OK

I am MOSTLY satisfied

I am VERY satisfied

Are you able to better deal with issues that you sought help with

My ability to deal with the issues I sought help with is the SAME

I can OCCASIONALLY deal with the issues I sought help with

SOMETIMES I can deal with the issues I sought help with

MOST OFTEN I am able to deal with the issues I sought help with

I am ALWAYS able to deal with the issues I sought help with

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