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For ongoing services and at discharge.

Please take a few minutes to fill out this satisfaction survey. Your answers will be kept confidential.

Thank you for your participation.

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* 1. Your Child's Name

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* 2. Your Name

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* 3. Relationship to Child

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* 4. What time point does this survey response represent?

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* 5. Your TEIS Therapist(s) are/were

  Speech Occupational Therapy Physical Therapy Developmental Vision Social Work Nutrition
Therapist

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* 6. My therapist provides me with activities that I can use in my child's routines

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* 7. I feel empowered with the skills to continue to support my child

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* 8. I have insight into my child's growth and development

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* 9. What would you like to see your therapist do differently?

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* 10. Would you recommend TEIS?  Why or why not?

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* 11. What do you find most helpful about your therapist?

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* 12. May we quote you in marketing materials?

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