Parent Satisfaction Survey (English)

SurveyID*
Family Size
Section Break
The Connections sign up was easy.
- Yes
- Somewhat
- No
The Ages and Stages Questionnaires (ASQ) are easy to fill out.
- Yes
- Somewhat
- No
My child’s first ASQ was at age:
age in years
- 0 - 1
- 1 - 2
- 2 - 3
- 4+
My child’s ASQ’s are completed by:
- Family
- Pediatrician
- Childcare
I received a quick response after submitting a questionnaire.
- Yes
- Somewhat
- No
- Not Applicable
The questionnaires have helped my family identify a delay in my child.
- Yes
- No
- Not Applicable
The parent coach call/email and materials I received were helpful.
- Yes
- Somewhat
- No
- Not Applicable
The parent coach referral (to Early On, Bright Beginnings, Ken-O-Sha, etc.) was helpful.
- Yes
- Somewhat
- No
- Not Applicable
The quarterly Connect with Connections newsletter I received contained helpful information.
- Yes
- Somewhat
- No
I feel supported by Connections.
- Yes
- Somewhat
- No
Connections has helped me feel confident to support my child’s development.
- Yes
- Somewhat
- No
Connections has helped me understand developmental milestones.
- Yes
- Somewhat
- No
Connections has helped me improve my parenting skills.
- Yes
- Somewhat
- No
Connections has helped reduce my stress and has given me peace of mind as a parent.
- Yes
- Somewhat
- No

What would you change about Connections to better support the needs of your family?
What is your favorite aspect of Connections?

Mind Mindedness
Please describe your child(ren) enrolled in the Connections program using the following space. Feel free to write down any characteristics of this child.
Child #1
MM1
Child #2
MM2
Child #3
MM3
Child #4
MM4
Child #5
MM5
Child #6
MM6
Child #7
MM7
Child #8
MM8
Child #9
MM9
Child #10
MM10

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