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
4.What time point does this survey response represent?
5.Your TEIS Therapist(s) are/were
Speech
Occupational Therapy
Physical Therapy
Developmental
Hearing
Nutrition
Therapist
6.My therapist provides me with activities that I can use in my child's routines(Required.)
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
7.I feel empowered with the skills to continue to support my child
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
9.What would you like to see your therapist do differently?
10.Would you recommend TEIS?  Why or why not?
11.What do you find most helpful about your therapist?
12.May we quote you in marketing materials?
13.Early intervention services have helped families effectively communicate their child's needs to doctors, teachers, and caregivers
14.Early intervention has helped families help their children develop and learn