AIP Client Survey

AIP Client Survey
How would you rate the overall experience of the AIP intake registration process?

Great Good Okay Needs Improvement (please explain below) Poor (please explain below)
Explain:
How would you describe the overall attitude of the staff providing information and assisting with intake registration?

Attentive Friendly Concerned Distracted Rushed Rude Other (please specify below)
Specify:
How would you rate the overall experience of the AIP intake process?

Great Good Okay Needs Improvement Poor (please explain below)
Explain:
How would you describe the overall attitude of the staff completing your intake?

Attentive Friendly Concerned Distracted Rushed Rude Other (please specify)
Specify:
How would you describe the overall attitude of your AIP group facilitator(s)?

Attentive Friendly Concerned Rushed Rude Other (please specify)
Specify:
My facilitator is meeting my expectations.

1

2

3

4

5

1 is Strongly Disagree, 5 is Strongly Agree
My facilitator is knowledgeable about the topic being discussed.

1

2

3

4

5

1 is Strongly Disagree, 5 is Strongly Agree
I feel like group is a safe place to share.

1

2

3

4

5

1 is Strongly Disagree, 5 is Strongly Agree
My facilitator showed genuine concern about myself and other group members.

1

2

3

4

5

1 is Strongly Disagree, 5 is Strongly Agree
I find the topics discussed in group to be helpful.

1

2

3

4

5

1 is Strongly Disagree, 5 is Strongly Agree
How would you rate the overall experience of the AIP?

Great Good Okay Needs Improvement (please explain below) Poor (please explain below)
Explain:
Were you court ordered to this program?

Yes No
This is my first time in the AIP.

True False
I have completed my ______ session:

1st-5th 6th-10th 11th-15th 16th-20th 21st-25th 26th-32nd
Overall, I am satisfied with the day and time in which I attend group.

1

2

3

4

5

1 is Strongly Disagree, 5 is Strongly Agree
Additional comments:
Should be Empty:

Now create your own JotForm - It's free! Create your own JotForm