Encuesta de Satisfacción de Cuidadores | Emerge Terapia Pediátrica

Caregiver Satisfaction Survey

Thank you for taking the time to complete this review. Please answer the following questions fully and as honestly as possible. This will help us to be sure that your child is receiving the best care possible and that we are able to make your experience at the clinic as positive as possible.

Caregiver Name*
First Last
Child's First Name*
First
Child's Last Name*
Last
Email*
Phone
Date*
MM slash DD slash YYYY
Services Received*
Please select all that are appropriate
- Speech-Language Therapy
- Occupational Therapy
- Physical Therapy
- Feeding Therapy
- Group Therapy
Therapist name:*
How likely are you to recommend Emerge Pediatric Therapy to a friend or colleague?*
Please select the answer that most honestly reflects your feeling at this point in time.
How likely are you to recommend your child's therapist to a friend or colleague?*
Please select the answer that most honestly reflects your feeling at this point in time.
What do you think your therapist does best?
What do you wish your therapist did better and/or differently?
I feel that my concerns are being addressed by my child's therapist.*
Please select the answer that most honestly reflects your feeling at this point in time.
I feel well equipped to implement taught strategies at home to support my child's ongoing progress.*
Please select the answer that most honestly reflects your feeling at this point in time.
Why did you choose to make Emerge your "therapy home?"
The convenience of our clinic hours is:*
Please select the answer that most honestly reflects your feeling at this point in time.
The helpfulness of the administrative staff on the telephone and in-person is:*
Please select the answer that most honestly reflects your feeling at this point in time.
Tell us anything else you'd like us to know!
Have a friend or family member in mind that might also benefit from services at Emerge?
If you would like to pay it forwards to them, please indicate "yes" below. We will send you a unique virtual coupon to share via email. This coupon is good for a free 30-minute screening with one of therapists.

Encuesta de satisfacción del cuidador

Caregiver Satisfaction Survey