Official Role with:
*
Please Select
Department of Child & Family Services
Probation Department
Courts
Foster Parents
Private Cases
County of Services:
*
Date:
*
-
Month
-
Day
Year
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Last name
*
What HGCF Services did you and your family receive?
*
Home-Based Casework
Home-Based Therapy (Individual / Family)
Counseling (Individual / Family) In-Office
Supervised Visitation at any Level
Homemaker / Parent Aid / Transportation
How long have you and your family worked with HGCF services?
*
Less than a month
1-3 months
3-6 months
6 months to 1 year
More than 1 year
Please rate your service satisfaction with each service you worked with HGCF services: Home-Based Casework
Very Satisfied (5)
Satisfied (4)
Somewhat Satisfied (3)
Less than Satisfied (2)
Not Satisfied (1)
Service Quality
1
2
3
4
5
HGCF Overall Service Satisfaction
6
7
8
9
10
Staff Timeliness with Services
11
12
13
14
15
Staff Responsiveness to Family Needs
16
17
18
19
20
Staff Kindness and Helpfulness
21
22
23
24
25
Staff Professionalism
26
27
28
29
30
Staff Knowledge of Their Work with Your Family
31
32
33
34
35
Staff Integrity to Services Offered
36
37
38
39
40
Please rate your service satisfaction with each service you worked with HGCF services: Home-Based Therapy
Very Satisfied (5)
Satisfied (4)
Somewhat Satisfied (3)
Less than Satisfied (2)
Not Satisfied (1)
Service Quality
41
42
43
44
45
HGCF Overall Service Satisfaction
46
47
48
49
50
Staff Timeliness with Services
51
52
53
54
55
Staff Responsiveness to Family Needs
56
57
58
59
60
Staff Kindness and Helpfulness
61
62
63
64
65
Staff Professionalism
66
67
68
69
70
Staff Knowledge of Their Work with Your Family
71
72
73
74
75
Staff Integrity to Services Offered
76
77
78
79
80
Please rate your service satisfaction with each service you worked with HGCF services: Counseling (Individual / Family)
Very Satisfied (5)
Satisfied (4)
Somewhat Satisfied (3)
Less than Satisfied (2)
Not Satisfied (1)
Service Quality
81
82
83
84
85
HGCF Overall Service Satisfaction
86
87
88
89
90
Staff Timeliness with Services
91
92
93
94
95
Staff Responsiveness to Family Needs
96
97
98
99
100
Staff Kindness and Helpfulness
101
102
103
104
105
Staff Professionalism
106
107
108
109
110
Staff Knowledge of Their Work with Your Family
111
112
113
114
115
Staff Integrity to Services Offered
116
117
118
119
120
Please rate your service satisfaction with each service you worked with HGCF services: Supervised Visitation
Very Satisfied (5)
Satisfied (4)
Somewhat Satisfied (3)
Less than Satisfied (2)
Not Satisfied (1)
Service Quality
121
122
123
124
125
HGCF Overall Service Satisfaction
126
127
128
129
130
Staff Timeliness with Services
131
132
133
134
135
Staff Responsiveness to Family Needs
136
137
138
139
140
Staff Kindness and Helpfulness
141
142
143
144
145
Staff Professionalism
146
147
148
149
150
Staff Knowledge of Their Work with Your Family
151
152
153
154
155
Staff Integrity to Services Offered
156
157
158
159
160
Please rate your service satisfaction with each service you worked with HGCF services: Homemaker / Parent Aid / Transportation
Very Satisfied (5)
Satisfied (4)
Somewhat Satisfied (3)
Less than Satisfied (2)
Not Satisfied (1)
Service Quality
161
162
163
164
165
HGCF Overall Service Satisfaction
166
167
168
169
170
Staff Timeliness with Services
171
172
173
174
175
Staff Responsiveness to Family Needs
176
177
178
179
180
Staff Kindness and Helpfulness
181
182
183
184
185
Staff Professionalism
186
187
188
189
190
Staff Knowledge of Their Work with Your Family
191
192
193
194
195
Staff Integrity to Services Offered
196
197
198
199
200
Suggestions for improvement: (If you feel that what you can add will improve our services, please do so below)
Additional comments: (Please use this area to discuss any special comments about your specific provider you'd like to add and/or issues you have encountered with our services)
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