Instructions: Your feedback is very important to us.  Please take a few minutes to fill out this annonymous form.  This information will be provided to the program supervisors.  The information you provide to us will be used to continuously monitor and improve our services to you and your family.

BI Confidential Client Satisfaction Survey

Sex of child? *
Please circle the number that corresponds with how much you agree with the statement.  NA is used if you never experienced the item.
 *
 1 (disagree)2345678910 (agree)NA
The BI treated us with courtesy and respect.
The BI scheduled an appointment with us within one week of contact.
The BI was professional and on time for each visit.
The BI explained what the program was about and the initial paperwork that needed to be completed.
The process of completing the assessment and treatment plan were easy.
The BI showed concern for my child.
The BI asked for my feedback regarding my child's behavior.
The BI took my child out of the house to do activities in the community.
My child looks forward to going out with the BI.
When my child came home he/she was happy they went.
The BI kept me informed about my child's progress.
The BI asked me to evaluate their service by the 4th visit.
The BI collected a "Weekly Behavioral Report"each week.
The BI gave me a "Weekly Behavioral Report"each week to complete.
The BI worked with my child's therapist.
The BI supervisor was available when needed.
I feel the program is helping my child.