Family Survey • Range Mental Health Center

Section 1

Please indicate how much you agree or disagree with each of the following statements about the services your child received in the past SIX months by selecting the number that best represents your opinion. If the statement is about something you or your child has not experienced, select “NA” to indicate it is not applicable.

Overall, I am satisfied with the services my child received.(Required)

I helped to choose my child’s services.(Required)

I helped to choose my child’s treatment goals.(Required)

The people helping my child stuck with us no matter what(Required)

I felt my child had someone to talk to when he/she was troubled.(Required)

I participated in my child s treatment.(Required)

The services my child and/or family received were right for us.(Required)

The location of services was convenient for us.(Required)

Services were available at times that were convenient for us.(Required)

My family got the help we wanted for my child.(Required)

My family got as much help as we needed for my child.(Required)

Staff treated me with respect.(Required)

Staff respected my family s religious/spiritual beliefs.(Required)

Staff spoke with me in a way that I understood.(Required)

Staff were sensitive to my cultural/ethnic background.(Required)

Section 2

As a result of the services my child and/or family received:

My child is better at handling daily life.(Required)

My child gets along better with family members.(Required)

My child gets along better with friends and other people.(Required)

My child is doing better in school and/or work.(Required)

My child is better able to cope when things go wrong.(Required)

I am satisfied with our family life right now.(Required)

What has been the most helpful thing about the services you and your child received over the last 6 months?(Required)

What would improve the services here?(Required)

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Family Satisfaction Survey

Section 1

Section 2