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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.

1. My child and I were treated with dignity and respect by all early intervention professionals throughout the early intervention evaluation process.
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2. I was satisfied with my initial service coordinator.
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3. I was satisfied with my on-going service coordinator.
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4. My Individualized Family Service Plans (IFSP’s) reflected my concerns and priorities for my child.
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5. I had the opportunity to participate in discussion about strategies, activities, and services with IFSP team members.
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6. My service coordinator(s) were as prompt as possible in arranging services for my child.
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7. My service coordinator(s) assisted my child and me with discharge from the Early Intervention system and (if applicable) with making the transition into the pre-school (3-5) system.
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8. My on-going service coordinator was as flexible and accommodating as possible with respect to holding appointments and meetings at times and places which were convenient for my child and for me.
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9. The needs of my child and family were listened to and respected throughout all phases of the Early Intervention process.
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10. The services that my child received were appropriate to his/her needs.
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11. Therapists and teachers who worked with my child were professional, reliable and skilled, including awareness of health and home safety (hand washing before and after sessions, used well maintained toys and equipment).
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12. Therapists and teachers included a parent or caregiver in each session, and explained activity(ies) in sessions and their relationship to functional goal(s) on my child’s IFSP. They provided carry through activities for parent or caregiver.
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13. Overall, I am satisfied with the services I received through the Early Intervention Program.
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May we contact you for more specific details on your responses?
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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.
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