Your Voice Counts!
We would love to hear your thoughts or feedback on how we can improve your experience!
What is Your Child's Name? *
What is Your Name? *
What is the best number we can reach you at? *
Email
What Program Area are you receiving services from?
What is your service provider's name? *
Does your provider seem to be professional and knowledgeable? *
Does your provider review treatment plan goals & objectives with you & your family? *
Based on your provider’s performance, would you refer others to AFE? *
Has your provider helped your family make progress towards your goals? *
Does provider address your concerns (questions, return calls, facilitate psych appointments, etc)? *
Does your provider treat you with dignity and respect? *
Does your provider follow through with the plans of care they propose to you? *
Does your provider stick to scheduled appointment dates and times? *
How long do provider sessions usually last? *
How many sessions did your provider conduct during the last 3 months? *
How would you rate your provider? (5 is the best, you love your provider) *
Worst
Best
What Suggestions for improvement do you have for us?
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