* 1. Our family received services from: (Please check all that apply)

* 2. Please rate your satisfaction with the following areas:

  Yes, Definitely Somewhat No,never
I am satisfied with the frequency and flexibility of when and where services are offered.
Staff demonstrated competent skills.
The individual plan that was developed for my child reflected the choices and priorities identified by my family.
My requests were responded to in a timely manner.
Our family was kept up to date on activities for my child.
I feel that our family was a partner with staff in planning and decision making.
I was familiar with procedures to complain or express my concerns.
I feel my culture and family background were respected.

* 3. Overall, I would rate my satisfaction with the quality of services that my family received from RMACL as:

* 4. What do you like best about the services you received?

* 5. What could be added or changed to improve the services RMACL provides?

* 6. Please complete only if you have received RESPITE SERVICES

  Yes Somewhat No
I believe the respite program helped my family be better able to cope with having a child with a disability.
I believe that a successful respite placement has contributed to my family's ability to care for our child.
Most or all of the criteria I had for selecting a respite placement were met.

* 7. Please complete only if you have received SUPPORTED CHILD DEVELOPMENT.

  Yes Somewhat No
I feel that my ability to advocate for my child has increased.
I feel I have increased strategies/ideas of how to support and encourage my child's development.
The childcare setting has increased skills in supporting families and children with extra support needs.

* 8. Please complete only if you have received CHILD AND YOUTH CARE SERVICES

  Yes Somewhat No
I believe that the Child and Youth Care program has helped our family to better cope with having a child with a disability.

* 9. Please answer only if you have received INFANT DEVELOPMENT SERVICES.

  Yes Somewhat No
I feel that my ability to advocate for my child has increased.
I feel that my knowledge of child development has increased.
I feel I have increased strategies/ideas of how to support and encourage my child's development.
Thank you for taking the time to respond!

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