Client Satisfactory Form – Pavo Behavioral Therapy

Client Satisfaction Survey

Step 1 of 7

14%

Your Name(Required)

First

Your Child's Name(Required)

First

Indicate the consistency with which the ABA Technicians do the following:

Arrive and depart on time for sessions(Required)

Always (5/5 times)

Usually (4/5 times)

Sometimes (3/5 times)

Seldom (2/5 times)

Never (0/5 times)

Dress appropriately(Required)

Always (5/5 times)

Usually (4/5 times)

Sometimes (3/5 times)

Seldom (2/5 times)

Never (0/5 times)

Communicate regarding the day's session(Required)

Always (5/5 times)

Usually (4/5 times)

Sometimes (3/5 times)

Seldom (2/5 times)

Never (0/5 times)

Provide answers to questions or give directions on how to get answers to questions(Required)

Always (5/5 times)

Usually (4/5 times)

Sometimes (3/5 times)

Seldom (2/5 times)

Never (0/5 times)

Are respectful in interacting with the family(Required)

Always (5/5 times)

Usually (4/5 times)

Sometimes (3/5 times)

Seldom (2/5 times)

Never (0/5 times)

Indicate the consistency with which your child's BCBA does the following:

Arrive and depart on time for sessions, meetings, parent training(Required)

Always (5/5 times)

Usually (4/5 times)

Sometimes (3/5 times)

Seldom (2/5 times)

Never (0/5 times)

Dress appropriately(Required)

Always (5/5 times)

Usually (4/5 times)

Sometimes (3/5 times)

Seldom (2/5 times)

Never (0/5 times)

Communicate regarding the day's session.(Required)

Always (5/5 times)

Usually (4/5 times)

Sometimes (3/5 times)

Seldom (2/5 times)

Never (0/5 times)

Provide answers to questions or give directions on how to get answers to questions.(Required)

Always (5/5 times)

Usually (4/5 times)

Sometimes (3/5 times)

Seldom (2/5 times)

Never (0/5 times)

Have the skills to provide the services my child needs.(Required)

Always (5/5 times)

Usually (4/5 times)

Sometimes (3/5 times)

Seldom (2/5 times)

Never (0/5 times)

Are respectful in interacting with the family.(Required)

Always (5/5 times)

Usually (4/5 times)

Sometimes (3/5 times)

Seldom (2/5 times)

Never (0/5 times)

Incorporates things parents/family have identified as needs into program.(Required)

Always (5/5 times)

Usually (4/5 times)

Sometimes (3/5 times)

Seldom (2/5 times)

Never (0/5 times)

Asks for and listens to input from parents.(Required)

Always (5/5 times)

Usually (4/5 times)

Sometimes (3/5 times)

Seldom (2/5 times)

Never (0/5 times)

Please rate the following over the past 6 months rate the following:

Direct therapy and individualized programming(Required)

Very Dissatisfied, would or have recommended others not to use Pavocare

Dissatisfied, I have had more negative than positive experiences

Neutral, I have had positive and negative experiences with this

Satisfied, I have had more positive than negative experiences

Very Satisfied, would or have recommended others to use Pavocare

Parent training and Communication(Required)

Very Dissatisfied, would or have recommended others not to use Pavocare

Dissatisfied, I have had more negative than positive experiences

Neutral, I have had positive and negative experiences with this

Satisfied, I have had more positive than negative experiences

Very Satisfied, would or have recommended others to use Pavocare

Coordination with other service providers (School, speech, OT, PT, other) with consent(Required)

Very Dissatisfied, would or have recommended others not to use Pavocare

Dissatisfied, I have had more negative than positive experiences

Neutral, I have had positive and negative experiences with this

Satisfied, I have had more positive than negative experiences

Very Satisfied, would or have recommended others to use Pavocare

Scheduling(Required)

Very Dissatisfied, would or have recommended others not to use Pavocare

Dissatisfied, I have had more negative than positive experiences

Neutral, I have had positive and negative experiences with this

Satisfied, I have had more positive than negative experiences

Very Satisfied, would or have recommended others to use Pavocare

Range of services provided(Required)

Very Dissatisfied, would or have recommended others not to use Pavocare

Dissatisfied, I have had more negative than positive experiences

Neutral, I have had positive and negative experiences with this

Satisfied, I have had more positive than negative experiences

Very Satisfied, would or have recommended others to use Pavocare

Billing and Insurance support(Required)

Very Dissatisfied, would or have recommended others not to use Pavocare

Dissatisfied, I have had more negative than positive experiences

Neutral, I have had positive and negative experiences with this

Satisfied, I have had more positive than negative experiences

Very Satisfied, would or have recommended others to use Pavocare

Effectiveness of the services(Required)

Very Dissatisfied, would or have recommended others not to use Pavocare

Dissatisfied, I have had more negative than positive experiences

Neutral, I have had positive and negative experiences with this

Satisfied, I have had more positive than negative experiences

Very Satisfied, would or have recommended others to use Pavocare

Cost of services(Required)

Very Dissatisfied, would or have recommended others not to use Pavocare

Dissatisfied, I have had more negative than positive experiences

Neutral, I have had positive and negative experiences with this

Satisfied, I have had more positive than negative experiences

Very Satisfied, would or have recommended others to use Pavocare

My therapists(Required)

Very Dissatisfied, would or have recommended others not to use Pavocare

Dissatisfied, I have had more negative than positive experiences

Neutral, I have had positive and negative experiences with this

Satisfied, I have had more positive than negative experiences

Very Satisfied, would or have recommended others to use Pavocare

My BCBA/BCaBA(Required)

Very Dissatisfied, would or have recommended others not to use Pavocare

Dissatisfied, I have had more negative than positive experiences

Neutral, I have had positive and negative experiences with this

Satisfied, I have had more positive than negative experiences

Very Satisfied, would or have recommended others to use Pavocare

In the past 6 months, the behaviors below have changed in the following ways:

Problem behavior with my child has(Required)

Decreased significantly

Decreased slightly

No change noticed

Increased slightly

Increased significantly

Language and communication use by my child has(Required)

Decreased significantly

Decreased slightly

No change noticed

Increased slightly

Increased significantly

Social awareness/interactions by my child has(Required)

Decreased significantly

Decreased slightly

No change noticed

Increased slightly

Increased significantly

Self-help skills and or independence has(Required)

Decreased significantly

Decreased slightly

No change noticed

Increased slightly

Increased significantly

My child's cooperation or listening to instructions has(Required)

Decreased significantly

Decreased slightly

No change noticed

Increased slightly

Increased significantly

Over the past 6 months parent training has:

Given me valuable information on how to have more successful interactions with my child(Required)

No training on this has occurred

Disagree, training did not do this

Neutral, I have had positive and negative experiences with this

Agree, training helped in this way

Given practice at using techniques to use with my child(Required)

No training on this has occurred

Disagree, training did not do this

Neutral, I have had positive and negative experiences with this

Agree, training helped in this way

Training has helped me respond to problem behavior with my child(Required)

No training on this has occurred

Disagree, training did not do this

Neutral, I have had positive and negative experiences with this

Agree, training helped in this way

Has helped me with how to increase communication and language use with my child(Required)

No training on this has occurred

Disagree, training did not do this

Neutral, I have had positive and negative experiences with this

Agree, training helped in this way

Has helped me with how to increase independent and self help skills with my child(Required)

No training on this has occurred

Disagree, training did not do this

Neutral, I have had positive and negative experiences with this

Agree, training helped in this way

Given me a way to track changes in my child's behavior(Required)

No training on this has occurred

Disagree, training did not do this

Neutral, I have had positive and negative experiences with this

Agree, training helped in this way

Indicate how interested you are in the training areas below:

How to handle challenging behavior(Required)

I have no interest in training on this topic

I might be interested in training on this topic

I would participate in an in home training on this topic

I would attend a training in home or in the office on this topic

I would pay to attend an in depth office training on this topic

Getting more communication from my child(Required)

I have no interest in training on this topic

I might be interested in training on this topic

I would participate in an in home training on this topic

I would attend a training in home or in the office on this topic

I would pay to attend an in depth office training on this topic

How to prevent problem behaviors(Required)

I have no interest in training on this topic

I might be interested in training on this topic

I would participate in an in home training on this topic

I would attend a training in home or in the office on this topic

I would pay to attend an in depth office training on this topic

Making certain times of day easier(Required)

I have no interest in training on this topic

I might be interested in training on this topic

I would participate in an in home training on this topic

I would attend a training in home or in the office on this topic

I would pay to attend an in depth office training on this topic

Increasing independence(Required)

I have no interest in training on this topic

I might be interested in training on this topic

I would participate in an in home training on this topic

I would attend a training in home or in the office on this topic

I would pay to attend an in depth office training on this topic

Increasing age-appropriate play skills(Required)

I have no interest in training on this topic

I might be interested in training on this topic

I would participate in an in home training on this topic

I would attend a training in home or in the office on this topic

I would pay to attend an in depth office training on this topic

Resources that are available in the area(Required)

I have no interest in training on this topic

I might be interested in training on this topic

I would participate in an in home training on this topic

I would attend a training in home or in the office on this topic

I would pay to attend an in depth office training on this topic

How to get the most out of your child's school experience(Required)

I have no interest in training on this topic

I might be interested in training on this topic

I would participate in an in home training on this topic

I would attend a training in home or in the office on this topic

I would pay to attend an in depth office training on this topic

Promoting teamwork between my child's professionals(Required)

I have no interest in training on this topic

I might be interested in training on this topic

I would participate in an in home training on this topic

I would attend a training in home or in the office on this topic

I would pay to attend an in depth office training on this topic

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Client Satisfaction Survey

Indicate the consistency with which the ABA Technicians do the following:

Indicate the consistency with which your child's BCBA does the following:

Please rate the following over the past 6 months rate the following:

In the past 6 months, the behaviors below have changed in the following ways:

Over the past 6 months parent training has:

Indicate how interested you are in the training areas below:

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Pavo Behavioral Therapy

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