Client Satisfaction Survey ~ Parent/Guardian

Parent/Guardian

Please answer the following questions about your experience at Northern Youth Services Inc.

Thank you for your participation. We value your feedback.

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* 1. Northern Youth Services Inc. program involvement:

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* 2. Were you treated with respect by our staff?

Definitely Yes

Probably Yes

Neutral

Probably Not

Definitely Not

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* 3. Were staff available when you needed them?

Definitely Yes

Probably Yes

Neutral

Probably Not

Definitely Not

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* 4. Were services provided to you in an accessible manner?

Yes

Somewhat

Comments:

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* 5. Do you feel you have been involved enough in the planning of your program (ex.: goal setting)? If not, please explain.

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* 6. If you were dissatisfied with Northern Youth Services Inc. in any way, please explain which part and why?

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* 7. Please tell us about specific areas where we can improve our services to you.

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* 8. Did you receive services in your preferred language?

Yes

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* 9. Although your response will be handled confidentially, you may not choose to complete this section:

Completed by:

Date:

Address

Telephone:

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* 10. If you would like to be contacted to discuss any issues you have relating to the services you received, please check here.

Yes