Intensive Family Preservation

Client Satisfaction Survey

Name*

First Last

Date*

1. This program was fully explained to my family during the first session:*

2. Home visits occurred at times that were convenient to my family:*

3. Staff were professional and polite to my family:*

4. I was involved in developing service goals:*

5. Staff respected my culture/ethnic:*

6. Staff listened to my concerns:*

7. Number of hours spent with staff met our needs:*

8. Overall, I was satisfied with services received:*

9.There has been improvement in the problems we sought help for:*

10. We are better able to continue working out problems on our own:*

11. We know how to access community resources to help meet our family’s needs:*

12. My parenting skills have improved:*

13. If we need help in the future, we are likely to request IFP:*

14. I know people who will listen and understand me when I need to talk:*

15. I have people I am comfortable talking to about my child’s problems:*

16. In a crisis, I would have the support I need from family or friends:*

17. I have people with whom I can do enjoyable things:*

18. I feel like my family has increased supports (formal and/or informal):*

19. Comments: