Client Feedback Survey

Today's Date

Date

Is this survey being completed for services received by a child or an adult?

In (or near) which city did you receive services?

Did you receive any of these Behavioral Health Services? (check all that apply)

Did you receive any of these Children & Family Services? (check all that apply)

Did you receive any of these Refugee & Immigration Services? (check all that apply)

Did you receive any of these Housing Services? (check all that apply)

How would you rate the following elements of the Root and Rise program?

Rows	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	Not Applicable
I have the resources needed to help me achieve my goals.
I have achieved any of my three goals since my enrollment.
I have learned a new skill because of my involvement with the Transitional Living Program (TLP)

How much do you agree with the following statements:

Rows	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	Not Applicable
I am satisfied with services from LFS.
My first appointment happened in a timely fashion.
I am treated with dignity and respect at LFS.
I feel welcome and safe at LFS.
LFS staff is sensitive to my cultural needs.
Services are provided at times & locations that are good for me.
If I had other choices, I would still get services from LFS.
I would recommend LFS to a friend or family member.
LFS staff is sensitive to any trauma experienced in my life.
Because of LFS services, my life has improved.
Because of LFS services, I am better able to handle things when they go wrong.
Because of LFS services, I’m better able to deal with a crisis.
I set my service / treatment plan goals with the help of LFS staff.
In a crisis, I would have the support I need from family, friends or other social supports (ex. neighbors, co-workers, sponsors).

What do you appreciate most about LFS? (Optional)

What would you like LFS to do differently? (Optional)

What other services could LFS provide that would be helpful to you? (Optional)

Survey language

Are you interested in additional services at Lutheran Family Services?

Other LFS Services

Your survey responses are confidential. If you choose to request information about other programs or services, the contact information you provide below will be used only to respond to your request. Your name, email address, and phone number will not be linked to your survey ratings or feedback responses. To learn more about our programs and services visit https://www.onelfs.org/get-help/

Please describe what service(s) you are interested in?

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Date of Birth

Date