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2. Placer County Department of Child Support Services
   Please answer the following questions regarding your recent office visit experience with the Placer County Department of Child Support Services.
4. 1. I am the:*

   1. Person receiving support
   2. Parent paying support
   3. Guardian / relative
   4. Other
6. Other (Please Specify)
8. 2. I am:*

   1. Male
   2. Female
10. 3. I am:*

    1. Under 18 years old
    2. 19 to 29 years old
    3. 30 to 40 years old
    4. Over 40 years old
12. 4. My most recent contact with a Child Support Professional was made:

    Check those that apply.

    1. In the office
    2. Over the phone
    3. In court
    4. In the mail
    5. Today
    6. In the last week
    7. In the last month
    8. In the last year
    9. Other
14. Other (Please Specify)
16. 5. My wait time to speak with a Child Support Attorney was:

    1. 0 to 15 minutes
    2. 16 to 30 minutes
    3. Over 30 minutes
18. 6. The wait time for my case to be called by the Commissioner was:

    1. Less than 1 hour
    2. 1 to 3 hours
    3. Over 3 hours
20. 7. Please rate your recent office visit experience with the Placer County Child Support Services.
22. My wait time for assistance was reasonable.

    1. Strongly Agree
    2. Agree

    1. Neutral
    2. Disagree

    1. Strongly Disagree
24. Those who assisted me were knowledgeable.

    1. Strongly Agree
    2. Agree

    1. Neutral
    2. Disagree

    1. Strongly Disagree
26. I was treated with respect.

    1. Strongly Agree
    2. Agree

    1. Neutral
    2. Disagree

    1. Strongly Disagree
28. I had enough time to discuss my situation.

    1. Strongly Agree
    2. Agree

    1. Neutral
    2. Disagree

    1. Strongly Disagree
30. I was given answers and explanations to my questions.

    1. Strongly Agree
    2. Agree

    1. Neutral
    2. Disagree

    1. Strongly Disagree
32. I was provided with options for my situation.

    1. Strongly Agree
    2. Agree

    1. Neutral
    2. Disagree

    1. Strongly Disagree
34. The outcome seemed fair to all involved parties.

    1. Strongly Agree
    2. Agree

    1. Neutral
    2. Disagree

    1. Strongly Disagree
36. The Department staff were well-organized.

    1. Strongly Agree
    2. Agree

    1. Neutral
    2. Disagree

    1. Strongly Disagree
38. It was convenient and easy to access a Child Support Professional.

    1. Strongly Agree
    2. Agree

    1. Neutral
    2. Disagree

    1. Strongly Disagree
40. I understand the process better after this interaction.

    1. Strongly Agree
    2. Agree

    1. Neutral
    2. Disagree

    1. Strongly Disagree
42. My child benefits from the services provided by the Department.

    1. Strongly Agree
    2. Agree

    1. Neutral
    2. Disagree

    1. Strongly Disagree
44. Without the help of the Department, my child might not receive the support he/she is entitled to.

    1. Strongly Agree
    2. Agree

    1. Neutral
    2. Disagree

    1. Strongly Disagree
46. I believe that the Department helps me to provide my child with support.

    1. Strongly Agree
    2. Agree

    1. Neutral
    2. Disagree

    1. Strongly Disagree
48. My overall experience was positive.

    1. Strongly Agree
    2. Agree

    1. Neutral
    2. Disagree

    1. Strongly Disagree
50. Court security treated me with dignity and respect.

    1. Strongly Agree
    2. Agree

    1. Neutral
    2. Disagree

    1. Strongly Disagree
52. My questions were answered by the Child Support Attorney.

    1. Strongly Agree
    2. Agree

    1. Neutral
    2. Disagree

    1. Strongly Disagree
54. The Child Support Attorney presented my position fairly.

    1. Strongly Agree
    2. Agree

    1. Neutral
    2. Disagree

    1. Strongly Disagree
56. My questions were answered by the Court.

    1. Strongly Agree
    2. Agree

    1. Neutral
    2. Disagree

    1. Strongly Disagree
58. 8. Contact Information (voluntary, but will help us improve our services and is confidential)
60. Name
62. Email Address
64. Phone Number
Leave This Blank:


66. 1. Receive an email copy of this form.
67. Email address

    This field is not part of the form submission.

68. Submit

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