Client Satisfaction Survey

Parent Name *

First Name

Last Name

Child Name *

First Name

Last Name

Date *

MM

DD

YYYY

Survey *

My child enjoyed his/her experiences:

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

My child benefitted from his/her experiences:

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I am satisfied with the services my child received this year:

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Staff helped me understand my child’s needs:

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Staff regularly communicated with me about my child’s performance and progress:

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Staff encouraged me to participate in the decision making process:

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

All of my concerns and recommendations were documented on the report updates:

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I am satisfied with the responsiveness of BAS:

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I am satisfied with the overall performance of BAS:

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I would recommend BAS to family and friends:

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree