child service evaluation form

Please complete the survey of the services you received from The Cottage. Thank you.

If you have any questions, comments, or concerns, feel free to contact our Crisis Hotline.

 
 

This information will only be shared with the organization’s Executive Director for the purpose of improving the services provided for survivors.

Name *
Name
Phone
Phone
Please include the best number to reach you at.
My Relationship to the child is: *
Directions: Please read the following statements and SELECT the level of agreement or disagreement that best matches your answer. Do not hesitate to add comments, questions, or concerns you have with The Cottage’s services in the space at the end of this section. We appreciate your time and efforts with this evaluation.
Physical and Emotional Needs *
Physical and Emotional Needs
I am now more aware of other sources of help for my child in my community.
I now have a better understanding of child abuse and its effects on victims and their families.
Stability/Resolution: *
Stability/Resolution:
I now have resources to help my child cope with the abuse.
I now have resources to help me, the caregiver, cope with the abuse.
I now have the resources to help the victim’s siblings cope with the abuse.
Understanding/Participating in the Criminal Justice System *
Understanding/Participating in the Criminal Justice System
I now have a better understanding of the rights of child abuse victims.
Safety *
Safety
I now know new ways to manage my child’s safety.
Satisfaction *
Satisfaction
I did not have to repeat my child’s story to multiple agencies since coming to The Cottage.
The resources I received helped me cope with the effects of the abuse my child experienced.
The Cottage made sure the services they provided took my culture, religion, and orientation into consideration.
I feel my child was comfortable working with the staff of The Cottage.
Did you know about The Cottage prior to the incident? *
Would you feel confident telling your friends about us if they were in need of our services? *

Thanks for your help!