Confidential

Parent Therapy
Feedback Form

Please fill this form so we can understand your child's therapy experience and improve our services.

Child Details

Child's Name*

Date of Contact*

Parent / Caregiver Name*

Therapist Name*

1. Does your child look forward to coming to therapy?*

2. Is the therapist engaging the child for the entire 40 minutes, including 5–10 minutes of parent coaching?*

3. Are you getting adequate therapy ideas / home strategies from the therapist?*

4. How would you rate the therapist's service and session engagement?*

1 = Needs improvement · 5 = Excellent

5. Are the goals in therapy being achieved periodically? What are your expectations?

6. Do you have any comments or feedback to improve our service?

7. Updates

8. Comments

9. Other concerns

Fields marked with * are required. Your responses are confidential.