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Parent Post-Placement Evaluation Form
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This form has been modified since it was saved. Please review all fields before submitting.
Placement Evaluation for Parents & Caregivers
Placement Name (required)
*
Surveys are only reviewed by Chester County Juvenile Probation Department and will NOT be shared directly with the placement provider
Your name (optional)
Child's name (optional)
1. The program was as explained to me.
Please check one:
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
2. The placement staff listened to what I had to say.
Please check one:
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
3. I had input into my child's treatment plan.
Please check one:
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
4. The placement staff followed the treatment plan.
Please check one:
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
5. My child's education needs were met.
Please check one:
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
6. The placement staff were committed to my child's best interest and safety.
Please check one:
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
7. The Probation Officer communicated with me while my child was in placement.
Please check one:
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
8. I was able to reach the placement staff without difficulty.
Please check one:
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
9. I was able to reach my child without difficulty.
Please check one:
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
10. Placement provided appropriate medical and dental care.
Please check one:
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
11. I had input into my child's discharge plan.
Please check one:
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
12. Overall, I was pleased with the placement's service.
Please check one:
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Please share any additional comments, suggestions, or note if you would like to be contacted by someone at Chester County Juvenile Probation to discuss your feedback and how to contact you.
PLEASE NOTE- The Chester County Juvenile Probation Department is legally mandated to report all abuse allegations, so you will be contacted directly if you note any concerns of that nature.
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