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. 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. 4

9. The consultation service positively affected the way I relate to children. 4

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?
Hannah has taught us how to be patient with Juelz and his different abilities, but more importantly how to give ourselves grace when we are frustrated with how we feel when he is having big feelings.

13. Would you recommend this consultation service to other childcare providers? Why or why not?
100%, Hannah is amazing. We are going to miss seeing her in our building.

14. How can this consultation service be improved?
Nothing, she is amazing, patient and understanding.

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:
We are going to miss you Hannah, feel free to stop by and visit anytime. Ms Brenda

OPTIONAL - Consultants Name:

OPTIONAL - Your Name: