Active Service Survey – Child

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

Your Information

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

Please indicate which of the following services you and your family have accessed at Intersect:

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

Please tell us how much you disagree or agree with the following:

I liked coming to Intersect.
Intersect helps me talk about feelings.
Intersect helps me get along better with family members.
Intersect helps me get along better with friends.
Intersect helps me do better at school.
I am better able to cope when things go wrong.

Please answer the following with either a Yes or a No:

Do you know why you come here?

Please complete the following sentences:

Consent(Required)
This field is for validation purposes and should be left unchanged.

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