TEIS Satisfaction Survey
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.
1.
Your Child's Name
2.
Your Name
3.
Relationship to Child
Parent
Non-parent relative
Babysitter
Nanny
Daycare provider
Other (please specify)
4.
What time point does this survey response represent?
Still receiving service(s)
Discharged from service(s)
5.
Your TEIS Therapist(s) are/were
Speech
Occupational Therapy
Physical Therapy
Developmental
Hearing
Nutrition
Therapist
-- Select an option --
Katie Blauth
Kelly DeStefano
Kasey Exacustides
Emily Fawcett
Kimberly Frazer
Kari George
Olivia McLane
Kristi Keele
Christie Linkes
Maureen O'Brien
Megan Robbibaro
Julie Stevens
Stacie Vodopivec
Paige Zimnik
-- Select an option --
Flo Angelo
Kristen Burke
Stephanie Cascio
Mary Ann Dias
Mia DiNardo
Sydney Gabriel
Julie Kingera
Julia Kuehn
Rebecca Lord
Kate Molyneaux
Allyson Munion
Julia Roberson
Jennifer Schreiner
Nicole Sciulli
Ashley Stiller
Kristin Tornabene
Janet Watkiss
Emmy Winslow
-- Select an option --
Nikki Berrian
Rachel Collins
Denise Dahl
Jamie Delorie
MacKenzie Duval
Nicole Markantone
Abby Johnson
Jessica Lish
Amanda Owens
Tara Reighard
Ann Rodgers
Jaime Ruffing
Jeff Salipante
Erin Santos
Julie Sealy
Kayla Seidl
Katie Shroyer
Danielle Silverstein
Joshua Wagner
Darcy Walker
Disa Weinheimer
Missy Weisenstein
-- Select an option --
Jessica DeGennaro
Haley Combs
Susan Duch
Kristina Farione
Katelyn Jones
Catherine Konstantinos
Eileen Lutz
Tracy Payne
Lauren Russell
Jennifer Lynn Smith
Tabatha Vadala
-- Select an option --
Maureen O'Brien
-- Select an option --
Sarah Grace Hayward
Ronelle Myers
*
6.
My therapist provides me with activities that I can use in my child's routines
(Required.)
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Other (please specify)
7.
I feel empowered with the skills to continue to support my child
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
8.
I have insight into my child's growth and development
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
9.
What would you like to see your therapist do differently?
10.
Would you recommend TEIS? Why or why not?
Yes
No
Undecided
Other (please specify)
11.
What do you find most helpful about your therapist?
12.
May we quote you in marketing materials?
No
Yes, By Name
Yes, Anonymously
13.
Early intervention services have helped families effectively communicate their child's needs to doctors, teachers, and caregivers
Yes
No
14.
Early intervention has helped families help their children develop and learn
Yes
No