1. The consultant responded to my referral in a timely manner. 3

2. The consultants role was clearly explained to me. 3

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. 3

9. The consultation service positively affected the way I relate to children. 3

10. Overall, I am satisfied with the consultation service I recieved. 3

11. I feel the referring situation has improved. 3

12. What is ONE thing youre doing differently because of the consultation service you received?
I feel like before I approach a difficult situation with the child, I frame my mindset in a different way than previously, which helps for a better outcome.

13. Would you recommend this consultation service to other childcare providers? Why or why not?
Yes. I feel Courtney has been a valuable resource and came with some practical advice.

14. How can this consultation service be improved?
At one point, while the child was having an outburst, I wonder if Courtney offering to step in to sort of model the behavior of the adult to me may have been a helpful experience.

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?

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):

Other comments:
Thank you!

OPTIONAL - Consultants Name:

OPTIONAL - Your Name: