SAFY Surveys:

IV-B Client Satisfaction Survey

Introduction

To be completed by the CLIENT receiving services from each contracted service provider.

Client

Service Provided

Provider

Questions

Answer the following questions for the above service being provided. For each question that you answer with "Disagree" or "Strongly Disagree", please utilize the comments section to provide details of concerns of the DCS ans suggest a solution.

The service provider reviewed the county referral form with me and explained the purpose of the service to be provided.

The service provider explained what would be expected from me regarding the service being provided.

The service provider reviewed the assessment completed on me or any other assessment being used to identify my strengths and needs.

The service provider allowed me to participate in developing long-term and short-term goals based on the strengths and needs identified in the assessment.

The service provider was respectful of my work schedule when scheduling appointments.

The service provider maintained all scheduled appointments and arrived timely for each appointment.

The service provider provided concrete ideas to help me meet the identified goals and provided examples of how to put each idea into action.

The service provider identified specific tasks for me to carry out between appointments and discussed my progress on the tasks at the next appointment.

The service provided allowed me adequate time to complete each task.

The service provider provided opportunities for me to demonstrate learned skills as a result of the services being provided.

The service provider reviewed my goals with me every month and identified progress or lack of progress on each goal.

The service provider assisted me with additional tasks to reach any goal when progress was not made.

The service provider returned my calls and answered my questions timely.

The service provider reviewed each monthly progress report with me prior to submitting it to the DCS.

The service provider provided factual information when discussing my progress at case conferences and in written reports to the DCS.

The service provider was helpful to me in reaching my short-term and long-term goals.

Please provide comments or suggestions for any question where you answered "Disagree" or "Strongly Disagree".

SAFY Survey Engine

IV-B Client Satisfaction Survey