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Fostering Futures Client Feedback Form

Fostering Futures Client Feedback Form

Thank you for taking the time to provide feedback about the Foundation 2 Fostering Futures program. We continually strive to improve our services and value all feedback from those who utilize our programs. For assistance, please call 319-362-1170.

I felt like my privacy was respected during my services.*
- 1 (extremely dissatisfied)
- 2 (somewhat dissatisfied)
- 3 (neutral)
- 4 (somewhat satisfied)
- 5 (extremely satisfied)
I felt like my service provider(s) were nonjudgemental.*
- 1 (extremely dissatisfied)
- 2 (somewhat dissatisfied)
- 3 (neutral)
- 4 (somewhat satisfied)
- 5 (extremely satisfied)
I felt like my service provider(s) were capable and qualified to meet my needs.*
- 1 (extremely dissatisfied)
- 2 (somewhat dissatisfied)
- 3 (neutral)
- 4 (somewhat satisfied)
- 5 (extremely satisfied)
I received services in a timely manner.*
- 1 (extremely dissatisfied)
- 2 (somewhat dissatisfied)
- 3 (neutral)
- 4 (somewhat satisfied)
- 5 (extremely satisfied)
I felt valued by my service provider(s).*
- 1 (extremely dissatisfied)
- 2 (somewhat dissatisfied)
- 3 (neutral)
- 4 (somewhat satisfied)
- 5 (extremely satisfied)
I felt supported by my case manager.*
- 1 (extremely dissatisfied)
- 2 (somewhat dissatisfied)
- 3 (neutral)
- 4 (somewhat satisfied)
- 5 (extremely satisfied)
I felt like I could reach out to my case manager when I was struggling.*
- 1 (extremely dissatisfied)
- 2 (somewhat dissatisfied)
- 3 (neutral)
- 4 (somewhat satisfied)
- 5 (extremely satisfied)
I felt like my case manager provided useful resources and referrals.*
- 1 (not at all)
- 2 (somewhat)
- 3 (no change)
- 4 (moderate increase)
- 5 (significant increase)
- Not applicable
I felt like my care plan was individualized and tailored to meet my needs.*
- 1 (extremely dissatisfied)
- 2 (somewhat dissatisfied)
- 3 (neutural)
- 4 (somewhat satisfied)
- 5 (extremely satisfied)
I feel better prepared to manage independent living once discharged from services.*
- 1 (extremely dissatisfied)
- 2 (somewhat dissatisfied)
- 3 (neutural)
- 4 (somewhat satisfied)
- 5 (extremely satisfied)

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305 2nd Ave SE
Cedar Rapids, IA 52401

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