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  1. Surveys
  2. 2016
  3. December
  4. W
  5. Week 12
0%
Questions marked with a * are required Exit Survey
 
 
How often do you attend counseling sessions at our agency?
 
Weekly
 
Monthly
 
Quarterly
 
Annually
 
 
 
Are you treated with respect by our office staff?
 
None of the time
 
Some of the time
 
Most of the time
 
All of the time
 
 
 
* How long have you been receiving Court-ordered services?
   
 
 
 
* What is the reason for your Court-ordered Therapy Sessions?
 
Child/Family Reunification
 
Psychiatric Evaluation (Voluntary or Involuntary)
 
Prison Release
 
Anger Management
 
Other

 
 
 
If Other Please Explain:
   
 
 
 
* Are you Currently on Any Medications?
   
 
 
 
* Has your mental health interfered with your normal social activities with family, friends, neighbors or groups?
 
Not At all
 
Slightly
 
Moderately
 
Quite A Bit
 
Almost all the time
 
 
 
* Has your mental health interfered with your hobbies or recreational activities?
 
Not at All
 
Slightly
 
Moderately
 
Quite a Bit
 
Almost totally
 
 
 
Since attending our agency do you feel a effective change in your Mental Health? 
 
Little to no change
 
Needs improvement
 
Well
 
Extremely Well
 
 
How satisfied are you with the following:
* My Social Worker keeps information about me confidential
-
* My Social Worker is honest and trustworthy
-
* I would be completely happy to see this Social Worker again
-