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Exit Survey
Milieu Exit Survey
Please take a moment to complete this survey. We would like to know how successful our work for you was, and if there is anything we could do differently next time to improve our service.
Individual/Family has received services from:
Residential Care
Day Services
Respite
Host Family Services
Time frame individual/family received service from this program:
Less than 3 months
3 - 6 months
6 - 12 months
More than a year
Did you experience a waitlist for services from Milieu?
Yes
No
If yes, how long were you on the waitlist?
Did you receive an Individual Family Handbook?
Yes
No
Were you provided with Milieu's philosophy and Milieu's practices of the program prior to entering programs?
Yes
No
If no, please indicate any additional information you may have found helpful:
Was there a team approach to care for you and your family?
Yes Definitely
Somewhat
No Never
Milieu provided information and answered my questions regarding services available to me and my family?
Yes Definitely
Somewhat
No Never
The frequency and flexibility of the services met my needs?
Yes Definitely
Somewhat
No Never
I felt the plan that was developed reflected my wishes, choices and identified priorities.
Yes Definitely
Somewhat
No Never
My needs were considered in the planning and scheduling of meetings.
Yes Definitely
Somewhat
No Never
Staff and Management demonstrated skills to make me feel comfortable.
Yes Definitely
Somewhat
No Never
I was made familiar with procedures to make complaints or express my concerns about services.
Yes Definitely
Somewhat
No Never
I was provided support during transition planning-day services, residential care, respite care, host family services.
Yes Definitely
Somewhat
No Never
I feel that my culture and family background were respected and included.
Yes Definitely
Somewhat
No Never
Were you satisfied with your vocational experience?
Yes Definitely
Somewhat
No Never
Were your home life schedules and activities based on your personal abilities and goals?
Yes Definitely
Somewhat
No Never
Were you supported and/or educated regarding: Health needs, safety awareness, rights and responsibilities?
Yes Definitely
Somewhat
No Never
I was given the opportunity to give feedback on the support services I needed to receive from Milieu.
Yes Definitely
Somewhat
No Never
Please tell us the reason you are leaving Milieu's Services.
Moving
Family Commitments
Temporary Placement
Services did not meet my needs
Other
If Other, please specify:
What did you like about our services?
What can we improve upon?
Additional Comments:
