Satisfaction Survey - One-to-one services

Title *

1. Which program have you recently received support from?

Child and Youth Mental Health (CYMH)

Sexual Abuse Intervention Program (SAIP)

PEACE Program (Children & Youth Experiencing Violence)

Youth Justice

Child and Youth Care

Child and Youth with Special Needs

Specify your own value:

If unsure, please explain

2. Are you satisfied with the services you have received?

Yes

No

Specify your own value:

Comments

3. Were there any barriers to receiving services?

Yes

No

Specify your own value:

Comments

4. Where could we do better?

5. Was the importance of confidentiality and consent discussed?

Yes

No

Specify your own value:

Comments

6. Was confidentiality maintained?

Yes

No

Specify your own value:

Comments

7. Do staff treat you and/or your family professionally with respect and courtesy?

Yes

No

Specify your own value:

Comments

8. Did the staff include you and/or your child in developing the plan for services?

Please explain:

9. Would you recommend services to others?

Comments:

10. If needed, would you feel comfortable coming back for services in the future?

Additional information:

Content Type

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