Initial Visit Caregiver Survey

0% of survey complete

Thank you for taking a few minutes to tell us about your experience with
Child and Family Advocacy Center.
If you have any additional questions about this survey or your experience at 
the center feel free to contact us at

jreed@capselkhart.org

The information you provide in this survey will help us to improve our services and better assist our clients.  The information you provide is confidential. Your answers will not be traced back to you, nor can this information be used in any legal proceedings.  Your participation in the survey is entirely voluntary - if you do not wish to answer a question, simply leave it blank.  Thank you again for taking the time to complete this and please let us know if we can be of further assistance!

What is your child's gender?

What is your child's race/ethnicity? Please choose one.

What is your child's general age?