Your feedback is important to us. We welcome and will use your feedback to improve coordinationa of service delivery. Please circle the number that best reflects your experience of the CFSP process.

* 1. 1). I was given ample opportunity to prepare for the meeting. (e.g. received invitation to attend, family goals and/or draft plan )

* 2. 2) I was given opportunities to share my thoughts during the CFSP meeting.

* 3. 3). The family goals have been broken down into clear measurable outcomes.

* 4. 4). The support plan reflects the family priorities and the strategies can be fit into family life and child care environment.

* 5. 5). My role in the action plan is clearly defined.

* 6. 6). If my main treatment goals/support plan were not identified in the CFSP, I was given the opportunity to incorporate my professionally related strategies in the action plan.

* 7. Is there anything you would have liked done differently? Please describe:

* 8. Participants in this CFSP: please check all that apply

* 9. Facilitated or Chaired by

* 10. Date:

* 11. Optional: This evaluation was completed by:

* 12. Phone Number:

* 13. You may contact me to discuss my response:

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