Functional Family Therapy

Family Self Report

We know that the process of talking with outsiders about your life, your hopes, and your challenges can be difficult and stressful. We also know that if we do our job well then you have a better chance of experiencing great benefits. So, we need to know how you feel we are doing. Your feelings, whether positive or negative or mixed, count and will make a difference. We hope you will give us feedback that can help us better serve your family and others. Thank you.

Identified Client Name*

First Last

Identified Client Date of Birth*

Name of Person Completing Form*

First Last

Relationship to Identified Client*

Client
Caregiver
Sibling
Relative
Other

Explain other relationship to client:*

Please use the scale below that best describes your experience

1. Please help us understand how you felt your family was doing before your first session.*

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2. Help us understand how you feel things are in your family now.*

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3. Overall, how confident or hopeful are you that your family will get better?*

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4. Overall, how much do you approve or disapprove of the way your therapist is treating your family?*

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5. Whether or not you agree with the way your therapist is treating your family, how much do you like your therapist?*

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6. How much do you trust your therapist?*

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7. How much do you feel your therapist trusts and likes you?*

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Today's Date*

FFT Family Self Report

FFT Family Self Report (rev 20201209)

Functional Family Therapy

Family Self Report

Please use the scale below that best describes your experience

Please click SUBMIT when completed