Restoration Family Services Forms

“Helping families provide missing pieces”

Welcome to the Restoration Family Services, Inc.’s “Service Forms” platform.

 

Please complete this survey to best of your ability.

 

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CONSUMER SATISFACTION SURVEY

    1. I like the services that I receive here.

    2. If I had other choices, I would still get services from this agency.

    3. I would recommend this agency to a friend or family member.

    4. I like receiving virtual therapy.

    5. Staff is willing to see me as often as I feel necessary.

    6. Staff returns my call promptly.

    7. Services are available at time which are convenient to me.

    8. I am able to get services which I believe are appropriate for me.

    9. The Staff believe that I can grow, change, and recover?

    10. I feel free to complain and/or express my grievances?

    11. The staff told me what side effects to watch out for.

    12. Staff respects my wishes about who is and is not to be given information about my treatment.

    13. The Staff is sensitive to my cultural background (race, religion, language, etc.)

    14. The staff helps me to obtain the information I need to take charge of managing my illness and/or challenges.

    15. I deal more effectively with daily problems.

    16. I am better able to control my life.

    17. I am better able to deal with crisis.

    18. I am getting along better with family.

    19. I do better in social situations.

    20. I do better in school and/or work.

    21. My symptoms are not bothering me as much.

    22. I can see a psychiatrist when I want to.

    23. I feel comfortable asking question about treatment.

    24. I have been given information about my rights.

    25. The staff has encouraged me to take responsibility for how I live my life.

    26. I have been encouraged to use consumer-run programs (support groups, drop-in centers, crisis phone lines, etc.).

    27. I decided my treatment goals along with my staff.

    28. My housing situation has improved.

    29. Gender

    30. Ethnicity

    31.Please use the space below to write any other comments or suggestions you have.

    32. Name (Optional)

    33. Today's date:





    Stand: 27/01/2023

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