Customer Satisfaction Survey Template Question Title * 1. Overall, how satisfied are you with the childcare received within the respite program? Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied Question Title * 2. How satisfied were you with the application process to receive respite care? Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied Question Title * 3. Are you satisfied with the amount of time your child spends in respite care? Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied Question Title * 4. On a scale of one to five, how much does your child enjoy the respite program? 5 - Loved it! 4 - Enjoyed going most of the time 3 - Neither enjoyed nor disliked the program 2 - Disliked going most of the time 1 - Did not want to attend Question Title * 5. How old is your child? (please select all that apply) 0-12 months 12-24 months 24-36 months 3+ years Question Title * 6. How long has your child been attending the respite program? 0-3 months 3-6 months 6-12 months Over a year Question Title * 7. Have you visited the Apple Blossom Day Homes website before? Yes No, but I was aware it existed No, I was unaware Apple Blossom had a website Question Title * 8. What supports and/or services are you accessing while utilizing respite care? Question Title * 9. Is there anything you would like to change about the respite program? Question Title * 10. Do you have any comments, questions, or concerns? Done