* 2. What is the full name of the client? (First and Last)

* 3. What is the full name of the parent/guardians of the client? (First and Last)

* 4. What is the home address of the client?

* 5. What is the primary contact number where the client can be reached?

* 6. What type of therapy was the client seen for?

* 7. Who was the clients Family Service Coordinator?

* 8. What was the exit day of the client?

This survey is indented to help identify ways MECA Therapies can improve as a company, and as a way to assess how satisfied you were with the services that were provided to you and your child. Your feedback is very important to us and is crucial to our future success, so please be as honest as possible in your responses. Also know that all gathered information is for internal purposes only and will not be disclosed or discussed with outside sources.
Please answer the following questions to the best of your ability.  Please respond to the following questions as they pertain to your child and their treatment.

* 9. Approximately how often did a MECA therapist or specialist see your child?

* 11. Please explain in further detail if your therapist/ specialist was NOT attentive to your specific needs.

* 13. Please explain in further detail how the quality of service could have been better.

* 15. Please explain in further detail why you were NOT satisfied with the amount of information received regarding your child's treatment and progress.

* 18. Please explain in further detail if you feel you were NOT treated with dignity and respect.

* 20. Please indicate why you would NOT want to recommend your friends and/ or family to MECA Therapies.

* 23. Please explain in further detail if your desired outcome was NOT achieved through the treatment your child received.

* 25. Please explain in further detail what could have gone better in the transition of programs.

Please rate the following items on a scale of 1-5, (1=POOR and 5= EXCELLENT).

* 28. As a company, what are some things that we are doing well?

* 29. What are some things we can improve on?

Thank you for taking the time to fill out this survey. We wish you the best in all your future endeavors.