Bella Smiles for Developmental Disabilities Specialized Day Center.  
 Bella Smile is seeking your input to start specialized day center for children with developmental disabilities. Be among the first hundreds people to respond and earn a gift card.  Your answers will determine whether this center is needed in Pierce County.  

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1.    Do you have a child or know a child diagnosed with Intellectual Developmental Disability? (examples of developmental disabilities include autism, behavior disorders, Rett syndrome, brain injury, cerebral palsy, down syndrome, fetal alcohol syndrome, intellectual disability, spina bifida.)

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2. If you say Yes to the previous question, 
What is the age?

What is the diagnosis?

Who is the primary caregiver?

What is your relationship to the kid if you are not the guardian? 



3. Is your child enrolled in any day program for example; day center, birth to three, preschool, elementary school, any other? 
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4. Do you have any specific barriers to having your child enrolled in any above-mentioned programs? If yes what are they? respite

5. Are you unable to work due to barriers related to your child’s care needs? If yes, please tell us more. some times

6. Would you like to be contacted for further information?

If yes please provide your contact details.

7. Would your child benefit from Bella Smiles for Development Disabilities providing transportation to and from school, and therapy support?
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8. What other support could be helpful for your child?
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9. What would be an ideal support that will help support your child's case? yes
10. Would you consider Bella Smiles for Developmental Disabilities to capture gap in services by providing an alternative space for support to be given such as ABA?
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