Client Feedback Questionnaire Questionnaire Question Title * 1. What does the word autism mean for you? Question Title * 2. How do you prefer to describe yourself? (please select one) Person with autism Autistic person Person with ASD Person with Autism Spectrum Disorder On the spectrum On the Autism Spectrum Neurodivergent Neurodiverse I Use multiple I don’t use any of the above listed It doesn’t matter to me I use something else (please specify) Question Title * 3. Please provide any additional information on why you made that choice Question Title * 4. When looking for support for yourself, what are you looking for? (please select all that apply) Treatment Programs (for example: skill building programs, play programs, communication programs, etc.) Therapy Intervention Coaching Services Consultation Respite Something else (please describe) Question Title * 5. What professionals are you looking for to work on goals and get support? (please select all that apply) Teacher Therapist Instructor Facilitator Coach Worker Support worker Something else (please describe) Question Title * 6. Is there anything else you think is important that we have missed or that you’d like to share with us? Your thoughts and ideas matter to us! Question Title * 7. Can we reach out to you for more feedback? Yes No Next
