SUPERIOR COURT OF CALIFORNIA COUNTY OF SANTA CLARA FAMILY COURT SERVICES PARENT SURVEY Family Court Services is asking for your feedback so that we can do a better job serving families. Please do NOT identify yourself. The information you provide is anonymous and will NOT affect your case. Please complete this form once you have completed your participation in the Custody Pilot Project or the Traditional mediation, assessment, or evaluation process. Thanks in advance for your help. 1. Your relationship to the child: Female Parent 2. 3. Ethnicity: List Please check any of the following issues that were present in your case: Domestic Violence 4. Drugs or alcohol Child abuse Male Parent Legal Guardian Other (please specify): The reception and telephone staff were: Select one from each column very courteous/respectful courteous/respectful discourteous/disrespectful very discourteous/disrespectful very helpful helpful unhelpful very unhelpful 5. Any written materials I received from Family Court Services were: very helpful helpful unhelpful very unhelpful 6. If the service received most recently was mediation, did you reach either a temporary or long term agreement on the custody and visitation issues? Yes No Name of the Family Court Services Mediator/Investigator providing the above service: 7. 8. Gender of Mediator/Investigator: Male Female Ethnicity of Mediator/Investigator. List: 9. The Mediator/Investigator explained the procedure to me: very clearly 10. clearly unclearly very unclearly I felt the Mediator/Investigator listened to me: strongly agree agree disagree strongly disagree 11. I felt the Mediator/Investigator understood the points I was trying to make even though he or she may not have agreed with me: strongly agree agree disagree strongly disagree This is NOT a complaint form. If you wish to register a complaint regarding how Family Court Services handled your case, you may obtain a complaint form from our clerical staff. FM-1039 REV 10/01/08 Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com 12. I believe the Mediator/Investigator spent enough time on my case. strongly agree agree disagree strongly disagree 13. I believe the service was provided in a (Select one in each column) manner: very fair fair unfair very unfair very helpful helpful unhelpful very unhelpful very professional professional unprofessional very unprofessional very unbiased unbiased biased very biased 14. I did not feel overly pressured by the Mediator/Investigator to go along with things I did not want. strongly agree agree disagree strongly disagree 15. How satisfied or dissatisfied are you with the service you received in Family Court Services? very satisfied satisfied dissatisfied very dissatisfied 16. The service was provided in a manner that it preserved self-determination even though I did not "get" everything I wanted. strongly agree agree disagree strongly disagree 17. The result of the service produced an agreement or recommendation that is likely to be safe and good for the child(ren), and safe for the family members. strongly agree agree disagree strongly disagree If the service received most recently was an emergency screening, assessment, recommendation or evaluation which resulted in a recommendation by the investigator: I agreed with all or most of the recommendation, and was willing to have it presented to the court for approval with no, or only minor, changes. I disagreed with an important part of the recommendation and did not want it submitted to the court without important changes. I believe the investigation was: very thorough thorough adequate very inadequate 18. The most helpful thing about the service was: 19. The most unhelpful thing about the service was 20. Other comments or suggestions: This is NOT a complaint form. If you wish to register a complaint regarding how Family Court Services handled your case, you may obtain a complaint form from our clerical staff. FM-1039 REV 10/01/08 Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com