EI Telehealth Family Survey
The Department of Public Health (DPH) and the Early Intervention Parent Leadership Project (EIPLP) would like to hear about your experience with receiving EI services during the COVID-19 pandemic. This is a 6-month follow-up survey to the one that was sent in April. Below are 11 questions that ask you about your telehealth services. It should take less than 10 minutes to complete and all questions are optional. Please only complete one survey per family. This survey will close November 15, 2020.

If you do not have access to the Internet, please contact the EIPLP at (617) 645-1763 from 12pm - 8pm on Mondays and Wednesdays, to complete the survey in person or if you need an interpreter.

This survey is also available in the following languages:
Arabic
Haitian-Creole
Portuguese
Spanish
Vietnamese
How old is your child?
Clear selection
How long have you received EI services?
Clear selection
How would you describe yourself? (please check all that apply)
Telehealth services were explained to me by my EI service provider.
My child and family are eligible for EI services and received telehealth services.
My child and family’s EI services are provided by: (please check all that apply)
Did you choose to have some or all of your services provided as a telehealth service?
If you decided not to have visits by telehealth, could you tell us why? (please check all that apply)
What services have you received by telehealth? (please check all that apply)
On a scale of 1 (not satisfied) to 5 (very satisfied), how satisfied are you with your telehealth services?
1 (not satisfied)
5 (very satisfied)
Clear selection
Please let us know why. Thoughts to consider: What do you like about telehealth visits? What do you not like about telehealth visits? How could telehealth visits be better for you?
Thank you for sharing your experience with us. Your input is vital to helping to make EI services and supports in Massachusetts better!
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy