EAS Feedback Survey

Question Title

* 1. Which EAS branch do you receive services from?

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* 2. How did you first hear about CEAS?

Internet search

Family or friend

Provider

Other

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* 3. How would you rate your overall satisfaction with CEAS services?

Very dissatisfied

Disatisfied

Neutral

Satisfied

Very satisfied

Very dissatisfied

Disatisfied

Neutral

Satisfied

Very satisfied

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* 4. Please rate the quality of therapy provided by the therapist(s) on your team.

Very poor

Poor

Average

Good

Excellent

Very poor

Poor

Average

Good

Excellent

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* 5. How satisfied are you with the number of therapy hours your child receives per week?

Very dissatisfied

Dissatisfied

Neutral

Satisfied

Very satisfied

Very dissatisfied

Dissatisfied

Neutral

Satisfied

Very satisfied

Question Title

* 6. Communication

	Very poor	Poor	Average	Good	Excellent
Following your initial contact with CEAS, how would you rate our communication of the next steps?	Following your initial contact with CEAS, how would you rate our communication of the next steps? Very poor	Following your initial contact with CEAS, how would you rate our communication of the next steps? Poor	Following your initial contact with CEAS, how would you rate our communication of the next steps? Average	Following your initial contact with CEAS, how would you rate our communication of the next steps? Good	Following your initial contact with CEAS, how would you rate our communication of the next steps? Excellent
How would you rate the lines of communication between yourself and members of your team?	How would you rate the lines of communication between yourself and members of your team? Very poor	How would you rate the lines of communication between yourself and members of your team? Poor	How would you rate the lines of communication between yourself and members of your team? Average	How would you rate the lines of communication between yourself and members of your team? Good	How would you rate the lines of communication between yourself and members of your team? Excellent
How would you rate the quality of communication between yourself and the billing department?	How would you rate the quality of communication between yourself and the billing department? Very poor	How would you rate the quality of communication between yourself and the billing department? Poor	How would you rate the quality of communication between yourself and the billing department? Average	How would you rate the quality of communication between yourself and the billing department? Good	How would you rate the quality of communication between yourself and the billing department? Excellent

EAS Feedback

Thank you for taking a few minutes to complete this survey and give us your valuable feedback.

Question Title

* 1. Which EAS branch do you receive services from?

Question Title

* 2. How did you first hear about CEAS?

Question Title

* 3. How would you rate your overall satisfaction with CEAS services?

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* 4. Please rate the quality of therapy provided by the therapist(s) on your team.

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* 5. How satisfied are you with the number of therapy hours your child receives per week?

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* 6. Communication

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* 7. Is there a member on your team you would like us to be made aware of? It may be out of concern or appreciation towards that individual.

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* 8. Please share with us anything else you feel we should know to improve our services.