Referral Survey

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Referral Survey

Complete Survey

Please complete the following survey in order to help us better meet your needs in the future.

Please select one of the following that best describes your title or position:
Judge
Family Court Worker
Guardian Ad Litem
Clerk of Court
Social Services
Attorney
Probation
Therapist

How many clients have you referred to CSC (or how many clients have you worked with that have used CSC per a court order) in the past year?
1-5 clients
6-10 clients
11-20
More than 20

With respect to the clients you have referred, how well has CSC met your recommendations?
Excellent
Satisfactory
Unsatisfactory

Do you think the individual/family you referred benefited from participating in our program?
Very Much
Somewhat
Not at all
Not applicable

Were CSC\'s staff and volunteers accessible?
Never
Sometimes
Always
Not enough contact to determine

Were CSC\'s staff and volunteers respectful?
Never
Sometimes
Always
Not enough contact to determine

Were CSC\'s staff and volunteers approachable?
Never
Sometimes
Always
Not enough contact to determine

Were CSC\'s staff and volunteers responsive?
Never
Sometimes
Always
Not enough contact to determine

Were CSC\'s staff and volunteers pro-active?
Never
Sometimes
Always
Not enough contact to determine

Were CSC\'s staff and volunteers communicative?
Never
Sometimes
Always
Not enough contact to determine

Do you view CSC\'s delivery of services as effective?
Never
Sometimes
Always
Not enough contact to determine

Do you view CSC\'s delivery of services as organized?
Never
Sometimes
Always
Not enough contact to determine

Do you view CSC\'s delivery of services as coordinated?
Never
Sometimes
Always
Not enough contact to determine

Do you view CSC\'s delivery of services as efficient?
Never
Sometimes
Always
Not enough contact to determine

Do you view CSC\'s delivery of services as responsive?
Never
Sometimes
Always
Not enough contact to determine

Do you view CSC\'s delivery of services as meeting the needs of clients?
Never
Sometimes
Always
Not enough contact to determine

If you have had an opportunity to review observation notes taken of supervised visits at CSC, how useful were they to you in your work?
Extremely useful
Useful
Somewhat useful
Not at all useful

If you have had an opportunity to review observation notes taken of supervised visits at CSC, please rate the quality of the observation notes provided.
Excellent
Above Average
Average
Below Average

In your opinion, with your clients experience in mind, please indicate which of the following best describes the focus of Childrens Safety Centers.
Child centered
Mother centered
Father centered
Mother and Child centered
Father and Child centered
Family centered

How confident are you that CSC will provide safe visitation for your referred clients?
Completely confident
Quite confident
Somewhat confident
Not at all confident

Are the current locations of our center and hours of availability convenient to the clients you serve? (If no, please enter explaination)
Yes

Overall, how would you rate CSC as a supervised visitation/exchange provider?
Excellent
Above Average
Average
Below Average

Additional Comments:

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