Support Shiloh House

Customer Satisfaction

It is important for us to get feedback on the quality of our services. We use your feedback to improve our treatment programs. Please complete the following questions. Your responses will be completely confidential, unless you provide your name or the name of the youth. Thank you for your help!

Please fill out the form below as completely as possible. Submissions are received by Shiloh House's quality assurance officer, and all information submitted is confidential and reported anonymously.

Relationship to youth who was served by Shiloh House:
Parent Case Manager GAL Other

Your Name (optional)

Youth's Name (optional)

Program & Servies Used:

Portland West
Portland East
Adams South
Independent Living Program
Longmont Vintage
Longmont Ranch
Day Treatment - Littleton
Day Treatment - Lincoln
Out Patient Therapy

Approximate Date of Youth's discharge from Shiloh House:

Additional Comments:

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