Youth Program Evaluation Form
Please take a few moments to complete this survey
Please select Program
Long-Term
Emergency Shelter
Therapeutic Foster Care
Community Bed
After-Care
1. Are you satisfied with the access to the treatment planning process and the assistance that you have received from the staff in working with you?
*
Yes
No
2. Are you satisfied that the program is doing an effective job in helping you?
*
Yes
No
3. Are you satisfied with the level of communication you have with the staff concerning your treatment?
*
Yes
No
4. Do you feel the program is responsive to your needs and that it is making a sincere attempt to help correct your problems areas through behavioral rehabilitation services?
*
Yes
No
5. Does staff use manner and treat you with respect?
*
Yes
No
Please select one options for the questions listed above.
*
Needs Major Improvement
Needs Improvement
Satisfied
Very Satisfied
Excellent
1.
2.
3.
4.
5.
Any comments, opinions, or suggestions concerning the staff or program would be appreciated.
Name
First Name
Last Name
Submit
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