Intake Satisfaction Survey – Child

Your feedback on the services at Intersect is important.

We use this information to make sure we are meeting your needs in a meaningful way, to identify areas we can improve on and to plan for the future.

What to know about this survey:

  • You don’t have to do it if you don’t want to.
  • Your responses are anonymous and confidential; you do not have to record your name.
  • Your answers will not affect your ability to access services at Intersect.

Please fill out as much information as possible.

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Your Information

How did you hear about Intersect Youth & Family Services?
Check all that apply
Did you contact us directly (self-referral) or were you formally referred by another agency/service provider in the community?
What kind of intake appointment did you have?

Please tell us how much you disagree or agree with the following statements:

I liked coming to Intersect.
I know what confidentiality is.
People listened to what I had to say.
I think Intersect is going to help my family.
I feel more hopeful now.

Please answer the following with either a Yes or a No:

Do you know how Intersect helps kids?
Do you know why you came here to visit us?

Please complete the following sentences:

Consent(Required)
This field is for validation purposes and should be left unchanged.

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