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* 1. My child/I received:

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* 2. Through the following Programs:

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* 3. Please tell us how you feel about our service.
Goals…The therapist helped you to develop a plan that met your child’s / your needs.

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* 4. Relationship…You felt heard and respected by the therapist.

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* 5. Treatment…Your therapist identified both your child’s/your strengths and challenges.

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* 6. Family Centered Care…You were invited to participate in treatment.

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* 7. Virtual Experience… How satisfied are you with your virtual experience if applicable?

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* 8. Outcome…How satisfied are you with the progress your child/you have achieved?

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* 9. Outcome…How satisfied are you overall with our services?

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* 10. What do we do well?

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* 11. What would improve our service for you, including our new virtual format?

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* 12. Comments:

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* 13. Would you like to be contacted to provide additional feedback?

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* 14. Contact me at:

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