1. McCord Center Adolescent Outpatient Services

 
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The William J. McCord Adolescent Treatment Facility considers it an honor to provide adolescent outpatient services to the citizens in our area. As such, we are continuously striving to improve our services and value your feedback. Please take 10 minutes to complete this confidential survey to help us improve.

*** NOTE: PLEASE ANSWER THESE QUESTIONS AS THEY PERTAIN TO THE ADOLESCENT. ***

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* 1. Please enter today's date

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* 2. Please provide your/your adolescent's name

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* 3. During the past 30 days, where have you been living the majority of the time?

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* 4. In the past 30 days, have you been employed

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* 5. What is the last grade you have completed?

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* 6. Do you have your GED?

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* 7. Are you enrolled in school or a job training program?

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* 8. In the past 30 days, have you been arrested or charged with any type of crime?

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* 9. In the past 30 days, how many nights have you spent in jail or a DJJ facility?

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