Early Intervention Program Parent Satisfaction Questionnaire

Complete this questionnaire if your child received EI services and is being discharged from the program.

Dear Parent:

Please help us to evaluate the Early Intervention Program, which your child has participated in, by taking a few minutes to answer the questions below. Your response will be useful in determining what practices work best and how we can refine the program for those we will be serving in the future.

We thank you in advance for your assistance.

You may enter your name here if you choose to do so or you may leave this section blank. Your responses are reviewed by the Quality Assurance Unit and they are considered confidential information.

If you do choose to provide the following information, it

  • will never be shared
  • will always be kept confidential
  • will never be used in any other county government application
Enter your ten digit phone number with no spaces or hyphens.