Easter Seals Child Satisfaction Survey
1.

Please enter today's date:
 

50 characters left.
2.

What services do you get at Easter Seals?
Occupational Therapy (OT)
Physical Therapy (PT)
Speech Therapy
Feeding Services
Counseling
The P.L.A.Y. Project
Applied Behavior Analysis (ABA)
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  • 500 characters left.
3.

Which location do you receive services at:
Peoria Facility
Bloomington Facility
4.

Do you know why you come to Easter Seals?
Yes
No
5.

Did someone tell you what you will be doing when you are at Easter Seals?
Yes
No
6.

Do you like coming to Easter Seals?
Yes
No
Sometimes
7.

Are Easter Seals staff nice to you?
Yes
No
Sometimes
8.

Do you sometimes get to choose what you do when you are at Easter Seals?
Yes
No
Sometimes
9.

Do you practice what you do here when you get home?
Yes
No
Sometimes
10.

Do you think you are doing better since you started coming to Easter Seals?
Yes
No
Sometimes
11.

What can you do now that you couldn't do before you started coming to Easter Seals?
 

350 characters left.
12.

If you were the boss at Easter Seals, what changes would you make?
 

350 characters left.
13.

Is there anything else you would like us to help you with?
 

350 characters left.