Individual/Family/Guardian Satisfaction Form
DDSi is dedicated to continuously improving our services. We are interested in your feedback about the services your family member/individual have received. Please respond to the survey questions by selecting the best response or typing your reply to a question as appropriate.
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Name of Individual Receiving Behavioral Support Services
*
First Name
Last Name
Name of DDSi Behavior Consultant
*
Julie Williams
Judy Hamrock
Allison Davis
LeAnne Secrest
Bruce Holder
Enjoli Turner
Julie Rohdy
Kara Chambers
Kiley Wheatley
Laurel Stewart
Stephanie Greer
Zach Walter
Name of Person Completing this Survey Form (Optional)
First Name
Last Name
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Our Behavior Consultant is professional.
*
1
2
3
4
5
Strongly Disagree
Strongly Agree
1 is Strongly Disagree, 5 is Strongly Agree
Our Behavior Consultant is dependable, shows up at scheduled times, and attends scheduled meetings.
*
1
2
3
4
5
Strongly Disagree
Strongly Agree
1 is Strongly Disagree, 5 is Strongly Agree
If a friend or family member were in need of services, I would recommend my Behavior Consultant and DDSi.
*
1
2
3
4
5
Strongly Disagree
Strongly Agree
1 is Strongly Disagree, 5 is Strongly Agree
We were solicited for input and included in treatment planning.
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1
2
3
4
5
Strongly Disagree
Strongly Agree
1 is Strongly Disagree, 5 is Strongly Agree
Our Behavior Consultant is knowledgeable and comes up with helpful solutions to problems.
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1
2
3
4
5
Strongly Disagree
Strongly Agree
1 is Strongly Disagree, 5 is Strongly Agree
Our Behavior Consultant is available when we needed them.
*
1
2
3
4
5
Strongly Disagree
Strongly Agree
1 is Strongly Disagree, 5 is Strongly Agree
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The best things about the DDSi clinician providing behavioral support services are…
If I had to be picky, it would be good for my DDSi clinician to try to improve…
Overall, my satisfaction with DDSi providing my behavioral supports has been…
If you would like to connect with a supervisor, please check the box below and enter your contact information.
Yes, I would like a supervisor to get in touch
Name
*
First Name
Last Name
Preferred Method of Contact
*
Phone
Email
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
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