GPYFS Family Resource Center - Satisfaction Survey & Hope Scale
PAGE 1 — Client Experience & Satisfaction
When did you visit the Family Resource Center?
*
-
Month
-
Day
Year
Date
Which GPYFS Family Resource Center location did you visit?
*
Altus
Hobart
What event or service did you participate in today?
*
Family Resource Center Services - Concrete Supports (Diapers/Wipes, Cleaning Supplies, Personal Hygiene Products, Etc.)
Group Connection – Parents as Teachers event at public library.
Emergency Assistance (Bill assistance, Food vouchers, etc.)
Parenting Support / Parenting Education
Resource Navigation / Referrals (housing, employment, etc.)
Other
Was this your first time receiving services from us?
*
Yes
No
How did you hear about us?
*
Social Media
Friend or Family Member
Another agency/organization
Walk-In
Other
How satisfied are you with the service you received today?
*
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
Staff treated me with kindness and respect
*
Strongly Agree
Agree
Neutral
Disagree
Strongly disagree
I felt comfortable and welcome during my visit.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly disagree
The staff understood my needs and concerns.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly disagree
The resources or services I received today were helpful.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly disagree
How likely are you to recommend the GPYFS Family Resource center to others?
*
Very likely
Likely
Maybe
Unlikely
Very unlikely
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Feedback
What was the most helpful part of your visit today?
Is there anything we could improve to better support you or your family?
Any other comments you would like to share?
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Hope Scale
Instructions: For the following questions, select the answer that best describes how you right now.
Do you feel more hopeful after this event or service today?
*
Yes
No
I can think of many ways to get out of a jam.
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
I energetically pursue my goals.
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
I feel tired most of the time.
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
There are lots of ways around any problem.
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
I am easily downed in an argument.
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
I can think of many ways to get the things in life that are important to me.
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
I worry about my health.
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
Even when others get discouraged, I know I can find a way to solve the problem.
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
My past experiences have prepared me well for my future.
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
I've been pretty successful in life.
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
I usually find myself worrying about something.
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
I meet the goals that I set for myself.
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
Submit
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