Intake Satisfaction Survey - Child

What you think matters! It helps us plan and make Intersect better for you and other kids. You might need help from a trusted adult to finish this survey.

What to know about this survey:

  • You don't have to do it if you don't want to.
  • Don't type your name. No one will know what your answers are so you can feel more comfortable to tell us what is on your mind about your time here.
  • Your answers will not hurt our feelings or make it so you can't come here.


Please fill out as much information as possible.

Your Information


School
Family Doctor / Pediatrician
MCFD
Hospital
Other Agency
Website / Internet
Other:
Contacted Intersect directly
Formally referred by:
I scheduled an intake appointment.
We had a walk-in intake.
Disagree Agree Not sure
Disagree Agree Not sure
Disagree Agree Not sure
Disagree Agree Not sure
Disagree Agree Not sure
Yes No
Yes No

 





Important: Click the "I'm not a robot" checkbox above, before clicking the 'SEND' button.