We are interested in your family’s experience at Five Counties Children’s Centre.  For each question, please tell us how much the event or situation has happened to you.  You can show your response by choosing ONE answer for each question (from not at all to a very great extent) that you feel best fits your experience. Please note that zero (0) is only used when the situation does not apply to you. In particular, we would like to know about your perception of the service you and your family has been receiving over the past year from our Centre.

Please note:  PEOPLE refers to those individuals who work directly with you or your child.  These may include speech and language pathologists, social workers, doctors, physiotherapists, occupational therapists, therapy aides, etc.

By completing this brief questionnaire you can help us to improve our services.  The questions are based on what parents like you have told us about the way our services are offered.  We would like your personal, confidential thoughts.  All your responses are confidential and will not affect the services that you receive at the Centre.  By returning the survey, you are consenting to have your confidential data included for review.  

Please complete the questionnaire before Friday, November 15, 2019.  Results of the survey and action taken as a result of this survey will be posted on the Five Counties Children’s Centre website (www.fivecounties.on.ca).  If you would like assistance in the completion of this questionnaire, please call Glenna Hemphill, 705-748-2337, ext. 100 or toll free at 1-888-770-9916, ext. 100.