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Loyalty RATE Survey
Home
Loyalty RATE Survey
Add words later
Loyalty Survey RATE
Step
1
of
6
16%
Demographics
Parent / Guardian First Name
(Required)
Parent / Guardian Last Name
(Required)
Parent / Guardian Mobile Phone
(Required)
Parent / Guardian Email
(Required)
Client Code
(Required)
When does your child receive services?
(Required)
9:00 AM - 3:00 PM
3:00 PM - 6:00 PM
Where is your child receiving services?
(Required)
In-Home
RCG Center
Hybrid (Center and In-Home)
Which Center?
(Required)
RCG Park
RCG Henrico
Does your child receive Transportation?
(Required)
No
Yes
Service Questions
Does your child receive ABA?
(Required)
No
Yes
Does your child receive SLP?
(Required)
No
Yes
Does your child receive OT?
(Required)
No
Yes
ABA Therapy Questions
Name of your child's primary ABA Therapist(s):
(Required)
Name of your child's Clinical Supervisor:
(Required)
Duration of time receiving ABA therapy services:
(Required)
Less than 6 months
6 to 12 months
Over 12 months
Do you believe your child’s ABA therapy is personalized to their unique needs and strengths?
Yes
No
How satisfied are you with the overall quality of ABA services provided by RCG?
1 - Very Dissatisfied
2
3
4
5
6
7
8
9
10 - Very Satisfied
On a scale of 1-10 where 1 means Very Dissatisfied and 10 means Very Satisfied
How satisfied are you with the responsiveness of your child’s ABA therapist?
1 - Very Dissatisfied
2
3
4
5
6
7
8
9
10 - Very Satisfied
On a scale of 1-10 where 1 means Very Dissatisfied and 10 means Very Satisfied
How satisfied are you with RCG supervisor communications and updates?
1 - Very Dissatisfied
2
3
4
5
6
7
8
9
10 - Very Satisfied
On a scale of 1-10 where 1 means Very Dissatisfied and 10 means Very Satisfied
How satisfied are you with RCG’s therapist communications and updates?
1 - Very Dissatisfied
2
3
4
5
6
7
8
9
10 - Very Satisfied
On a scale of 1-10 where 1 means Very Dissatisfied and 10 means Very Satisfied
How satisfied are you with the consistency and reliability of your child’s therapy schedule?
1 - Very Dissatisfied
2
3
4
5
6
7
8
9
10 - Very Satisfied
On a scale of 1-10 where 1 means Very Dissatisfied and 10 means Very Satisfied
How do you rate your child's progress in ABA therapy over the past six months?
1 - No Progress
2
3
4
5
6
7
8
9
10 - Great Progress
On a scale of 1-10 where 1 means No Progress and 10 means Great Progress
How satisfied are you with the responsiveness of your child’s ABA Clinical supervisor?
1 - Very Dissatisfied
2
3
4
5
6
7
8
9
10 - Very Satisfied
On a scale of 1-10 where 1 means Very Dissatisfied and 10 means Very Satisfied
SLP Therapy Questions
Name of your child's SLP provider
Do you believe your child’s SLP therapy is personalized to their unique needs and strengths?
Yes
No
How do you rate your child's progress in SLP therapy over the past six months?
1 - No Progress
2
3
4
5
6
7
8
9
10 - Great Progress
On a scale of 1-10 where 1 means No Progress and 10 means Great Progress
How satisfied are you with the overall quality of Speech services provided by RCG?
1 - Very Dissatisfied
2
3
4
5
6
7
8
9
10 - Very Satisfied
On a scale of 1-10 where 1 means Very Dissatisfied and 10 means Very Satisfied
How satisfied are you with Speech Language Pathology communications and updates?
1 - Very Dissatisfied
2
3
4
5
6
7
8
9
10 - Very Satisfied
On a scale of 1-10 where 1 means Very Dissatisfied and 10 means Very Satisfied
OT Therapy Questions
Name of your child's OT provider
Do you believe your child’s OT therapy is personalized to their unique needs and strengths?
Yes
No
How do you rate your child's progress in OT therapy over the past six months?
1 - No Progress
2
3
4
5
6
7
8
9
10 - Great Progress
On a scale of 1-10 where 1 means No Progress and 10 means Great Progress
How satisfied are you with the overall quality of OT services provided by RCG?
1 - Very Dissatisfied
2
3
4
5
6
7
8
9
10 - Very Satisfied
On a scale of 1-10 where 1 means Very Dissatisfied and 10 means Very Satisfied
How satisfied are you with OT and updates?
1 - Very Dissatisfied
2
3
4
5
6
7
8
9
10 - Very Satisfied
On a scale of 1-10 where 1 means Very Dissatisfied and 10 means Very Satisfied
Center Operations Questions
How satisfied are you with the responsiveness of your child’s center operations team?
1 - Very Dissatisfied
2
3
4
5
6
7
8
9
10 - Very Satisfied
On a scale of 1-10 where 1 means Very Dissatisfied and 10 means Very Satisfied
How satisfied are you with center operations communication and updates?
1 - Very Dissatisfied
2
3
4
5
6
7
8
9
10 - Very Satisfied
On a scale of 1-10 where 1 means Very Dissatisfied and 10 means Very Satisfied
How satisfied are you with the responsiveness of center operations team?
1 - Very Dissatisfied
2
3
4
5
6
7
8
9
10 - Very Satisfied
On a scale of 1-10 where 1 means Very Dissatisfied and 10 means Very Satisfied
How satisfied are you with RCG Transportation communications and updates?
1 - Very Dissatisfied
2
3
4
5
6
7
8
9
10 - Very Satisfied
On a scale of 1-10 where 1 means Very Dissatisfied and 10 means Very Satisfied
General Feedback Questions
How satisfied are you with RCG’s efforts to continuously improve services based on feedback?
1 - Very Dissatisfied
2
3
4
5
6
7
8
9
10 - Very Satisfied
On a scale of 1-10 where 1 means Very Dissatisfied and 10 means Very Satisfied
How would you rate RCG’s value of your input and collaboration regarding the goal-setting process for your child's therapy?
1 - Very Dissatisfied
2
3
4
5
6
7
8
9
10 - Very Satisfied
On a scale of 1-10 where 1 means Very Dissatisfied and 10 means Very Satisfied
On a scale from 1-10, how do you rate your confidence in RCG to provide the best possible service delivery for your child?
1 - No Confidence
2
3
4
5
6
7
8
9
10 - Complete Confidence
On a scale of 1-10 where 1 means No Confidence and 10 means Complete Confidence
What aspects of your child's therapy experience at RCG do you appreciate the most?
Can you share an example of a positive impact therapy has had on your child and/or family?
What is your Primary preferred method for you to communicate with your child’s therapy team outside of scheduled sessions?
(Required)
Text
Call
Email
In person/virtual
What is your Secondary preferred method for you to communicate with your child’s therapy team outside of scheduled sessions?
Text
Call
Email
In person/virtual
Comments
This field is for validation purposes and should be left unchanged.
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