Please complete this survey about your experience with your home visitor. Your responses will be kept confidential and separate from your contact information, if you choose to provide that. 

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* 1. What home visiting program are/were you enrolled in?

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* 2. My home visitor and I work well together.

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* 3. I feel comfortable talking with my home visitor.

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* 4. My home visitor listens to me. S/he does not tell me what to do.

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* 5. My home visitor communicates with me in a way that I understand.

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* 6. My home visitor gives me information that is useful to me. 

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* 7. My home visitor helps me figure out how to get the community resources that I need. 

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* 8. My home visitor respects my culture, values, and beliefs. 

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* 9. My home visitor is on time and comes for our regularly scheduled visits. 

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* 10. My home visitor makes me feel good about becoming/being a parent. 

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* 11. I would recommend this program to a friend. 

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* 12. What about this program has been the most helpful to you and your family? 

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* 13. What could be improved about this program? 

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* 14. If you choose to provide your contact information, your name will be entered into a drawing to win a gift card.

0 of 14 answered
 

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