RTFT Caregiver Satisfaction Survey rev 20210114 rev. 2021-01-14 Reunification-Therapeutic Family Time Caregiver Satisfaction Survey Client Name* First Last Client's Date of Birth* MM slash DD slash YYYY Is the parent/primary caregiver completing the satisfaction survey?* Yes No Please select the response that best reflects your level of satisfaction.1. Home visits occurred at times that were convenient to my family.* Strongly Agree Agree Disagree Strongly disagree Does not apply 2. Staff were professional and polite to my family.* Strongly agree Agree Disagree Strongly disagree Does not apply 3. I was involved in developing service goals.* Strongly agree Agree Disagree Strongly disagree Does not apply 4. Staff respected my culture/ethnic background.* Strongly agree Agree Disagree Strongly disagree Does not apply 5. Staff listened to my concerns.* Strongly agree Agree Disagree Strongly disagree Does not apply 6. Number of hours spent with staff met our needs.* Strongly agree Agree Disagree Strongly disagree Does not apply 7. Overall, I was satisfied with the services receieved.* Strongly agree Agree Disagree Strongly disagree Does not apply 8. There has been improvement in the problems we sought help for.* Strongly agree Agree Disagree Strongly disagree Does not apply 9. We are better able to continue working out problems on our own.* Strongly agree Agree Disagree Strongly disagree Does not apply 10. We know how to access community resources to help me meet my family's needs.* Strongly agree Agree Disagree Strongly disagree Does not apply 11. My parenting skills have improved.* Strongly agree Agree Disagree Strongly disagree Does not apply 12. I know people who will listen and understand me when I need to talk.* Strongly agree Agree Disagree Strongly disagree Does not apply 13. In a crisis, I would have the support I need from family or fiends.* Strongly agree Agree Disagree Strongly agree Does not apply 14. My child benefited from this experience.* Yes No 15. How would you rate the quality of the service you and your child received?* Excellent Good to excellent Good Fair to good Fair Poor to fair Poor Please click SUBMIT when completed
