2015 Children Services Customer Survey

We want to know your opinion about our services. Please complete the on-line survey and follow the instructions to submit your answers directly to the Quality Improvement Department. The information you provide is confidential. We appreciate your input.

1. Today's date:


2. Your race/ethnicity:

3. What is your age group?

4. What is your gender?

5. How are you related to the children?

6. Are the children living: