1. The consultant responded to my referral in a timely manner. 4

2. The consultants role was clearly explained to me. 4

3. I felt I had a good relationship with the consultant. 4

4. I believe the consultation service was helpful. 3

5. I felt listened to by the consultant. 4

6. The consultant respected my opinions. 4

7. The consultant answered my questions. 4

8. I learned new ways to help children with challenging behaviors.

9. The consultation service positively affected the way I relate to children.

10. Overall, I am satisfied with the consultation service I recieved. 4

11. I feel the referring situation has improved. 3

12. What is ONE thing youre doing differently because of the consultation service you received?
We didn’t really change anything at home because as it was communicated prior to services the behaviors were only happening at daycare

13. Would you recommend this consultation service to other childcare providers? Why or why not?
Yes

14. How can this consultation service be improved?
I do wish that it would have been more visit around when Karlie comes back from visits or the day after a visit with bio mom

15. To be answered by the family: Over the past 30 days, how many days of work or school has the family/caregiver missed due to the challenges a child has experienced while in child care? 0

16. To be answered by the family: Please rate your stress level related to your child’s challenges at ChildCare(please edit if you like the idea of adding it): 2

Other comments:

OPTIONAL - Consultants Name:

OPTIONAL - Your Name: