Client Satisfaction Survey

Thank you for your participation in the 2025 PALS Client Survey

Your feedback is very important in helping PALS improve our services and programs. This survey will take approximately 15 minutes of your time and you can skip any questions you do not feel comfortable answering. It will also remain anonymous unless you decide to put in your name and contact information. All information will be kept confidential within the PALS organization; personal information will not be shared. If the client is a minor please have a parent or guardian complete this survey. If you have any questions about the survey, please contact Chris Herring chris@palsindiana.org | (812) 336-2798

1. How long have you/the client been participating at PALS?

For each statement below, check the box that corresponds with your level of your agreement or disagreement. Caregivers may fill this out for their PALS participant client.

2. I receive professional and courteous service and instruction from the PALS Staff.

3. I feel comfortable discussing questions and concerns I may have with my PALS instructor.

4. My sessions at PALS have a positive effect on my overall health and well-being.

5. Participating at PALS helps me reach my specific goals.

6. I feel safe and supported during all parts of my session.

7. The PALS facility is clean and organized during my visits.

8. I find my sessions at PALS fun and enjoyable.

9. I would recommend the PALS program.

10. What benefits have you/the client seen or experienced from participating at PALS? Please check all that apply.

If you selected other, please describe:

11. Please rate your overall experience with PALS:

Please answer the following questions honestly. We welcome all suggestions, concerns, and or compliments as we strive to continuously improve our programing.

12. How has the PALS program helped you/the client achieve goals?

13. What do you/the client like most about the PALS program?

14. How can we improve our program?

15. How did you learn about PALS? Please select all that apply.

If you selected other, please describe:

The following questions are demographic questions. Please note that you can skip any questions you do not feel comfortable answering. With this demographic data we are able to learn more about the clients we serve and how we can better assist our community.

16. Do you/the client have a physical, emotional/social, or cognitive diagnosis? Please select all that apply.

Physical disability

Emotional/social disability

Cognitive disability

I/the client does NOT have a disability

What physical diagnosis(es) do you/the client have? Please select all that apply.

If you selected other, please describe:

What emotional/social diagnosis(es) do you/the client have? Please select all that apply.

If you selected other, please describe:

What cognitive diagnosis(es) do you/the client have? Please select all that apply.

If you selected other, please describe:

17. What is the name of the client receiving services from PALS?

18. If the client is a minor, what are the names of the client's parent(s) or guardian(s)?

19. What is the client's gender?

20. What is the client's age?

21. What is the client's race/ethnicity? Please select all that apply.

22. Where is the client's primary residence? If the client splits time among multiple locations please check all that apply.

If you selected other, please describe:

23. How many people, including the client, currently reside in the client's primary household?

24. How many residents in the household were claimed as dependents on your most recent federal tax return?

25. Is there more than one person in the client's primary residence with a disability?

Yes

Other

If you selected other, please describe:

26. What is the estimated combined gross income of the client’s primary household on the most recent federal tax return. Please include income for all family members and include all sources—salary, bonuses, investment income, rents, royalties, etc.

27. Which therapy program(s) is the client currently involved with in addition to PALS? Please check all that apply.

If you selected other, please describe:

28. If the client does have a diagnosis, what are the approximately monthly health-related expenses incurred each month, not including PALS? (Sample expenses include things like medical care, therapy services, day care, miscellaneous supplies, and so on)

29. From which state or federal programs dos the client/client household currently receive support? Please select all that apply.

If you selected other, please describe:

We’re seeking families who are open to sharing data, such as school report cards, progress reports, or other relevant information that highlights changes or improvements since participating in PALS programs. Your contributions could play a pivotal role in helping us apply for and secure grants that directly support our mission.

Would you be interested in helping PALS with the above?

Yes – Please enter contact information in next section.

Maybe

Contact Information

Please leave your name and phone number or email below if you would like someone from PALS to contact you to discuss any of your experiences with our programs or if you would like to assist PALS in gathering data for grants that help keep our lessons affordable.

Name

First

Last

Phone