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. 4

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. 4

12. What is ONE thing youre doing differently because of the consultation service you received?
Working with myself and the children, realizing that every child is different and may need different things to help them learn & grow

13. Would you recommend this consultation service to other childcare providers? Why or why not?
Yes I definitely would, I feel like she did a very great job and was understanding.

14. How can this consultation service be improved?
No area for improvement

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): 1

Other comments:

OPTIONAL - Consultants Name:

OPTIONAL - Your Name: