Families Feedback Form 
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What is your name?
Tell us a bit about you *
Required
What is the age of the child(ren) you support? *
What are your child's additional needs? *
Required
Where do you get your information about your child's needs from? *
Required
Can you share some of your favourite sources from above? E.g. book title, instagram handle etc. *
How do you and your child communicate with each other? *
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How do you know when your child has understood you? *
Required
How do you know when your child has not understood you? *
Required
How often are breakdowns in communication happening for your family? *
What does a breakdown in communication look like for your child(ren)? *
Required
How does it feel for you when these breakdowns happen? *
What communication strategies do you use with your child at home? *
Required
Does the person you are supporting currently access speech therapy?  *
If your child is currently accessing speech therapy, what are their goals? If not, type N/A. *
How would you rank the following goals in priority order?  *
Most Important
Very Important
Fairly Important
Important
Slightly Important
Least Important
For my child to understand what is being communicated to them
For my child to communicate in ways they can be understood
For my child to use spoken language
For my child to use social skills such as turn-taking when interacting with others
For my child to be a confident communicator
For my child and our family to have less communication breakdowns
How much experience do you have with visual supports? *
Not much at all
I use them frequently and feel well informed about visual supports
What do you think visual supports are? *
Required
Who do you think needs and uses visual supports? *
Required
What do you think visual supports are used for? *
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Would you consider using visuals with your child for the following skills? Check the boxes that apply. *
Yes
No
To support working memory
To support understanding and comprehension of instructions and questions
To teach routines
To support learning in school
To teach ADLs (activities of daily living such as teethbrushing)
To teach and encourage more spoken language
To relieve anxiety by keeping them informed
To forewarn my child of changes and surprise events
To teach my child a sense of time and when things happen throughout the day, week or month
What are the barriers to using visuals for you? *
Required
How likely are you to make and use visuals? *
No, I'm not interested.
Yes I really want to try using visuals with my child
Would you be interested in learning about visual supports and how they might help your child? *
If you answered 'yes' to the previous question, please insert your email so we can send resources your way!
Any additional comments or thoughts?
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