Active Service Survey – Caregiver

Your feedback on the services at Intersect is important.

We use this information to make sure we are meeting your needs in a meaningful way, to identify areas we can improve on and to plan for the future.

What to know about this survey:

  • You don’t have to do it if you don’t want to.
  • Your responses are anonymous and confidential; you do not have to record your name.
  • Your answers will not affect your ability to access services at Intersect.

Please fill out as much information as possible.

MM slash DD slash YYYY

Child/Youth's Information

Person completing the Survey Information

The total number of sessions my child/youth and I have attended so far is (best guess):

Please specify the following services you and your child/youth have accessed at Intersect:

Individual therapy/counselling
Family therapy
EFFT parent work
Intersect School Program
Referrals to other services

What services did you get from Intersect while you were on the waitlist:

Please indicate how much you agree with the following statements:

I have been included in the assessment of my child/youth's mental health.
I know what the Individual Service Plan/Mental Health Goals are.
I have been included in Individual Service Planning/Mental Health Goal setting.
I understand what confidentiality is.
My child/youth's culture and religious beliefs are respected.
My child/youth’s gender and sexual orientation are respected.
We have made progress toward our goals since coming to Intersect.
My child/youth has more healthy and effective coping skills since coming to Intersect.
My family has been able to talk about emotions more effectively since coming to Intersect.
My relationship with my child/youth/family has improved.
I have a greater understanding of what my child/youth is going through.
I know about other resources in the community that can help my child/youth/family.
I feel supported by my child/youth's counsellor/therapist in community meetings (i.e. school, hospital, etc.).
I am aware of when my family should expect to have completed counselling/therapy.
I know what to do if I have a concern or complaint about the services my family receives at Intersect.
I worry about people knowing my child/youth comes to Intersect.
I feel safe while at Intersect.
I feel respected while at Intersect.
I feel comfortable while at Intersect.
I feel more hopeful since coming to Intersect.
I would refer my friends/family to Intersect.

Please rate your level of satisfaction with the following:

The hours Intersect is open.
The appearance and cleanliness of the building.
The physical accessibility of the building (e.g. ramps, stairs, etc.).
The length of time we were on the waitlist.
The time of day when services were scheduled.
The courtesy and respectfulness of staff.
Psychology services.
Psychiatry services.
Groups you attended.
Intersect School Program.
Counselling/Therapy services.
Website content.
Overall, how satisfied are you with the quality of services you have received so far?

This field is for validation purposes and should be left unchanged.

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