Schwartz Center for Children Consumer Satisfaction Survey: Early Intervention
	We appreciate your help as we work with you to provide the best for your child. We want to hear from you because your child is important to us. Your input about our services, both to you and your child, is necessary to improve what we do. Thank you for completing this online survey. The information you provide will only be used by the Schwartz Center. For more information, please visit our website at www.schwartzcenter.org.
	1*. Please provide child's name:
	2. Please provide the following information: Date of Admission Date of Discharge Person Completing Survey Relationship Email address (optional)
	3. Please list the services that your child is receiving. Check all that apply. Speech Therapy Physical Therapy Occupational Therapy Home Visits Community Groups Center Groups Assessment only
	4. Did you receive the parent/client information packet which included patient's rights as a part of admission? Yes No
	5. Did you receive prompt attention when you first contacted the center? Yes No
	6. Were you given the opportunity to participate in the development of your Family Service Plan (FSP)? Yes No
	7. Do you feel that you are treated as an important and equal member of the team? Yes No
	8. Did you receive (are receiving) the kind of service or help you expected or needed from the Center? Yes No
	9. Are you satisfied with the communication between your child's therapist and yourself regarding your child's program and progress? Yes No
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