Parents and Agency Evaluation Form
Please take a few moments to complete this survey
Please select Program
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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 and your child?
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Yes
No
2. Are you satisfied that the program is doing an effective job in helping your child?
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Yes
No
3. Are you satisfied with the level of communication you have with the staff concerning your child's treatment?
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Yes
No
4. Do you feel the program is responsive to your child's needs and that it is making a sincere attempt to help correct your problems areas through behavioral rehabilitation services?
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Yes
No
5. Does staff use manner and treat you and your child with respect?
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Yes
No
6. Are you satisfied with the referral and application process?
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Yes
No
7. Are you satisfied with the facility accepting youth as described in the agency's proposal?
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Yes
No
Please select one options for the questions listed above.
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Needs Major Improvement
Needs Improvement
Satisfied
Very Satisfied
Excellent
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2.
3.
4.
5.
6.
7.
Any comments, opinions, or suggestions concerning the staff or program would be appreciated.
Name
First Name
Last Name
Relationship
Submit
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