Follow-Up Survey


Parent/Guardian Name *
Parent/Guardian Name
*Child(ren) that Unplowed Ground was implemented with.
Which service(s) did you complete? *
Select the degree to which you agree/disagree for each statement regarding your child. *
Select the degree to which you agree/disagree for each statement regarding your child.
Your child is able to do the Big 6 on a normal basis.
Your child has stopped using the five tests on you.
Your child no longer exhibits behavioral concerns.
Your child is able to trust you as their caregiver.
Your child is accepting of boundaries.
Your child is able to form healthy relationships.
Your child is respecting of authority (to you and others).
Your child is talking out their feelings rather than acting them out.
Your child is able to show genuine affection.
Your child is willing/able to accept your love.
*signature
Do you give King's Ranch permission to use part of the information provided in this form as a testimonial on social media platforms? *
*This will use your first name only. Ex: Amanda, adoptive mom