We specialize
in providing teens
with positive
coping skills and a
new outlook on life!

We offer a variety
of skills and
activities including:
Camping
Hiking
Canoeing
Solo Challenge
Backpacking
Low Impact Skills
Wild Edibles
Caving
Swimming
Environmental Ed.

& Much More!
A great way to
learn about yourself.
What's Your
Adventure Therapy?
Therapeutic Outdoor Programs
© 2011 New Vision Wilderness, LLC  1580 S. 81st St., West Allis, WI 53214  admission (414) 801-9791  office/fax (414) 744.6288  info@newvisionwilderness.com
Inspiring Change...By Nature.
New Vision Wilderness - Therapeutic Outdoor Programs
Post-Program Parent Questionnaire
Your Name:*
 Date:*
Current Address:
 E-mail:
Clients Name:*
 Phone Number:
Program Type:*
 Dates of
Participation:*
*required field
1) Please rate the overall degree of change
your child has demonstrated after
attending NVW?
1= no change   2= some change  3= significant change  
1        2        3       n/a
2) Has your child demonstrated positive
behavior changes in any of the following
areas after attending NVW?
1= no change   2= some change  3= significant change  
1        2        3       n/a
Drug and/or Alcohol use

Criminal Activity            

School Attendance     

Aggression       
  
Opposition

Family Interactions   
Other:
3) Did your child demonstrate any changes
in areas of personal growth after attending
NVW?
1= no change   2= some change  3= significant change  
1        2        3       n/a
Self Esteem                     

Confidence

Responsibility     

Adaptability       

Resiliency

Self Awareness

Motivation   
Other:
4) In what skills did your child show
improvement after attending NVW?
1= no change   2= some change  3= significant change  
1        2        3       n/a
Communication              

Conflict Resolution         

Problem Solving   

Self Regulation: control
over emotions       

Anger Management   

Social Skills
Other:
5) Did you pursue the New Vision Wilderness follow up therapy recommendations for your child?
Yes               No
If no, why:
6) How was your child referred to the program?
7) Was your child voluntary or mandated to volunteer in the NVW program?
Voluntary
Mandated
8) Did your child receive a successful completion certificate after participating in the NVW program?
Yes               No
9) Please state the 3 goals that were determined at the initial intake assessment
1.
2.
3.
10)                                                  Please Rate the Following
1= Needs Improvement    2= Satisfactory    3= Good    4= Very Good    5= Excellent
1        2        3       4       5
Goal Achievement             

Program Communication      
  
Therapist Communication
Responsiveness

Response to child's needs    
    
Quality of programming

Family Day Presentation
Therapist name:
11) Are there any aspects of the program you feel could use improvement?
Yes               No
If yes, what:
12) What did you like most about this program, and why?
13) Would you recommend this program/service to others?
Yes               No
If no, why:
14) May NVW utilize you as a potential reference?
Yes               No
We value your honest feedback and thank you for your time!
Additional questions, comments, or
feedback:
Call Admissions
414-801-9791