Please answer all questions, adding any comments you'd like to make in the spaces provided.

The information on your report will be used to evaluate the quality of our services that your loved one receives.

(If checked House Above)

Please choose excellent, good, fair, poor or I don't know to answer the questions below:

Please give your answers to the following questions by using the blank space provided.
Please feel free to comment separately on each program your family member is enrolled in.

We would appreciate receiving your most current address, phone numbers, and email address:

  • Fred Erlich, or call at (518) 218-0000 x4317
  • Steve Klein or call at (518) 218-0000 x4312
  • Kim Darling, or call at (518) 218-0000 x4320

Contact Us

300 Washington Avenue Extension
Albany, NY 12203
Main: (518) 218-0000
Fax: (518) 862-2175