Client Feedback Survey

We are in the process of reviewing our quality of services to better serve our community. Your feedback is essential to making ongoing improvements. We thank you kindly for your time. There is no better compliment than a referral.

1. Tell us about you.

	yes	no
Are you currently a client?	*Tell us about you. Are you currently a client? yes	Are you currently a client? no
Were you a client in the past?	Were you a client in the past? yes	Were you a client in the past? no

Comments:

*
2. Has your child participated in 2010 Helper Hands/CIT Camp at Seattle Therapy Network?

Has your child participated in 2010 Helper Hands/CIT Camp at Seattle Therapy Network? yes

no (skip to questions 5)

3. If your child participated in Helper Hands Camp, what changes did you see in your child during the 3 weeks of camp?

If your child participated in Helper Hands Camp, what changes did you see in your child during the 3 weeks of camp?

4. What could we have done to make Helper Hand Camp easier for you and your family at home?

What could we have done to make Helper Hand Camp easier for you and your family at home?

5. What do you like about Seattle Therapy Network?

What do you like about Seattle Therapy Network?

6. What would you like to see Seattle Therapy Network improve?

What would you like to see Seattle Therapy Network improve?

*
7. Please mark your level of agreement with the following statements.

	strongly agree	agree	neutral	disagree	strongly disagree	N/A
I received the interest, care and attention I expected:	*Please mark your level of agreement with the following statements. I received the interest, care and attention I expected: strongly agree	I received the interest, care and attention I expected: agree	I received the interest, care and attention I expected: neutral	I received the interest, care and attention I expected: disagree	I received the interest, care and attention I expected: strongly disagree	I received the interest, care and attention I expected: N/A
My family was involved in program planning, goal making, and decision making:	My family was involved in program planning, goal making, and decision making: strongly agree	My family was involved in program planning, goal making, and decision making: agree	My family was involved in program planning, goal making, and decision making: neutral	My family was involved in program planning, goal making, and decision making: disagree	My family was involved in program planning, goal making, and decision making: strongly disagree	My family was involved in program planning, goal making, and decision making: N/A
I am satisfied with my/my child's occupational therapy program?	I am satisfied with my/my child's occupational therapy program? strongly agree	I am satisfied with my/my child's occupational therapy program? agree	I am satisfied with my/my child's occupational therapy program? neutral	I am satisfied with my/my child's occupational therapy program? disagree	I am satisfied with my/my child's occupational therapy program? strongly disagree	I am satisfied with my/my child's occupational therapy program? N/A
I would recommend occupational therapy services to another family:	I would recommend occupational therapy services to another family: strongly agree	I would recommend occupational therapy services to another family: agree	I would recommend occupational therapy services to another family: neutral	I would recommend occupational therapy services to another family: disagree	I would recommend occupational therapy services to another family: strongly disagree	I would recommend occupational therapy services to another family: N/A
I am satisfied with my/my child's physical therapy program?	I am satisfied with my/my child's physical therapy program? strongly agree	I am satisfied with my/my child's physical therapy program? agree	I am satisfied with my/my child's physical therapy program? neutral	I am satisfied with my/my child's physical therapy program? disagree	I am satisfied with my/my child's physical therapy program? strongly disagree	I am satisfied with my/my child's physical therapy program? N/A
I would recommend physical therapy services to another family.	I would recommend physical therapy services to another family. strongly agree	I would recommend physical therapy services to another family. agree	I would recommend physical therapy services to another family. neutral	I would recommend physical therapy services to another family. disagree	I would recommend physical therapy services to another family. strongly disagree	I would recommend physical therapy services to another family. N/A

Comments:

8. Here is a list of the services we provide at Seattle Therapy Network. Please let us know if you are aware of the service and whether or not you have utilized it. Please check all that apply.

	I use this service	I am aware of this service	I am satisfied with this service
Occupational Therapy	*Here is a list of the services we provide at Seattle Therapy Network. Please let us know if you are aware of the service and whether or not you have utilized it. Please check all that apply. Occupational Therapy I use this service	Occupational Therapy I am aware of this service	Occupational Therapy I am satisfied with this service
Physical Therapy	Physical Therapy I use this service	Physical Therapy I am aware of this service	Physical Therapy I am satisfied with this service
Speech Therapy	Speech Therapy I use this service	Speech Therapy I am aware of this service	Speech Therapy I am satisfied with this service
Constraint Induced Therapy Programs	Constraint Induced Therapy Programs I use this service	Constraint Induced Therapy Programs I am aware of this service	Constraint Induced Therapy Programs I am satisfied with this service
Parent's Night Out	Parent's Night Out I use this service	Parent's Night Out I am aware of this service	Parent's Night Out I am satisfied with this service
Team Consultation	Team Consultation I use this service	Team Consultation I am aware of this service	Team Consultation I am satisfied with this service
School/Community visits	School/Community visits I use this service	School/Community visits I am aware of this service	School/Community visits I am satisfied with this service
Home Programs	Home Programs I use this service	Home Programs I am aware of this service	Home Programs I am satisfied with this service
Pilates Reformer Instruction	Pilates Reformer Instruction I use this service	Pilates Reformer Instruction I am aware of this service	Pilates Reformer Instruction I am satisfied with this service
Myofascial Release	Myofascial Release I use this service	Myofascial Release I am aware of this service	Myofascial Release I am satisfied with this service
Craniosacral Work	Craniosacral Work I use this service	Craniosacral Work I am aware of this service	Craniosacral Work I am satisfied with this service
Yoga for the Special Child	Yoga for the Special Child I use this service	Yoga for the Special Child I am aware of this service	Yoga for the Special Child I am satisfied with this service
Social Groups	Social Groups I use this service	Social Groups I am aware of this service	Social Groups I am satisfied with this service
Self-Regulation Groups	Self-Regulation Groups I use this service	Self-Regulation Groups I am aware of this service	Self-Regulation Groups I am satisfied with this service
Birthday Parties	Birthday Parties I use this service	Birthday Parties I am aware of this service	Birthday Parties I am satisfied with this service

Comments:

9. If you would like to leave a testimonial for use in our marketing or web materials, please use this area to leave us a comment on your experience with Seattle Therapy Network, our therapists, or how therapy has impacted your family.

Please indicate how you would like your name to appear in marketing materials (i.e. name, initials, anonymous) at the end of your comments.

If you would like to leave a testimonial for use in our marketing or web materials, please use this area to leave us a comment on your experience with Seattle Therapy Network, our therapists, or how therapy has impacted your family. Please indicate how you would like your name to appear in marketing materials (i.e. name, initials, anonymous) at the end of your comments.

Client Feedback Survey
Exit this survey

1. Feedback

1. Tell us about you.

*
2. Has your child participated in 2010 Helper Hands/CIT Camp at Seattle Therapy Network?

3. If your child participated in Helper Hands Camp, what changes did you see in your child during the 3 weeks of camp?

4. What could we have done to make Helper Hand Camp easier for you and your family at home?

5. What do you like about Seattle Therapy Network?

6. What would you like to see Seattle Therapy Network improve?

*
7. Please mark your level of agreement with the following statements.

8. Here is a list of the services we provide at Seattle Therapy Network. Please let us know if you are aware of the service and whether or not you have utilized it. Please check all that apply.

Client Feedback SurveyExit this survey

1. Feedback

1. Tell us about you.

*2. Has your child participated in 2010 Helper Hands/CIT Camp at Seattle Therapy Network?

3. If your child participated in Helper Hands Camp, what changes did you see in your child during the 3 weeks of camp?

4. What could we have done to make Helper Hand Camp easier for you and your family at home?

5. What do you like about Seattle Therapy Network?

6. What would you like to see Seattle Therapy Network improve?

*7. Please mark your level of agreement with the following statements.

8. Here is a list of the services we provide at Seattle Therapy Network. Please let us know if you are aware of the service and whether or not you have utilized it. Please check all that apply.

Client Feedback Survey
Exit this survey

*
2. Has your child participated in 2010 Helper Hands/CIT Camp at Seattle Therapy Network?

*
7. Please mark your level of agreement with the following statements.