Customer Satisfaction

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

Your Name (optional)

Youth's Name (optional)

Program & Servies Used:

Approximate Date of Youth's discharge from Shiloh House:

1. Could you reach the therapist when you called, either directly or by leaving a message?
   No Comment Never Rarely Sometimes Almost Always Always
2. Did staff respond to your concerns?
   No Comment Never Rarely Sometimes Almost Always Always
3. Did staff communicate with you about the youth's progress or difficulties in the program?
   No Comment Never Rarely Sometimes Almost Always Always
4. Were you invited to attend school and treatment meetings?
   No Comment Never Rarely Sometimes Almost Always Always
5. Were staff in all departments courteous, progessional and respectful in their interactions with you and your child?
   No Comment Never Rarely Sometimes Almost Always Always
6. Were the program rules, consequences, and policies clearly explained?
   No Comment Never Rarely Sometimes Almost Always Always
7. Did your therapist see you on a regular basis and keep all appointments as scheduled?
   No Comment Never Rarely Sometimes Almost Always Always
8. How would you rate the progress of you and your child toward treatment goals?
   No Comment None Less than expected Moderate More than expected Complete

Additional Comments: