Early Intervention Caregiver Satisfaction Survey
This survey is to be completed by the caregiver of a child receiving services from Bright Beginnings Therapy Services. Please complete a separate survey for each service that your child receives (i.e., Occupational Therapy, Physical Therapy, Speech Therapy, and Special Instruction). The survey should take only a few minutes to complete.

If you would like to speak to someone concerning your child’s services from Bright Beginnings, please call 716-625-4002. Your input is valued and appreciated. Thank you for your time
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Bright Beginnings Therapy Services
Type of Service
Therapist's/Teacher's Name
Were services initiated in a timely manner?
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Comment
Are services provided as written in your child’s service plan (number of visits per week, length of visits)?
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Comment
Is a schedule given regularly so you are aware of scheduled appointment times and are you notified regarding absences or changes in schedule?
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Comment
Does the provider consider your family’s needs when scheduling appointments?
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Comment
Does the provider arrive on time or call if late (more than 15 minutes)?
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Comment
Does the provider practice infection control by washing/sanitizing hands prior to working with your child?
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Comment
Have you been informed of your child’s progress?
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Does the provider give you activities/suggestions to work on with your child?
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Does the provider demonstrate a high level of knowledge in their field and explain what he/she is working on and why?
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Does the provider have a good rapport with you?
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Does the provider have a good rapport with your child?
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Is the provider courteous to you and others in your family and does he/she treat you with respect?
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Do you feel you are a participating member of the IFSP and your input is included in formulating and rating goals?
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Do you feel your child has benefited from these services?
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Do you feel confident that your service provider keeps information regarding your child confidential, sharing only with those people on the Release of Information Form that you have signed?
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Comment
Please provide any additional comments that might help us better serve your child in the future.
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