Parent Feedback Form

Family Feedback Form

As we prepare our plan to reopen with strict precautions in place, please complete the survey to share your preferences.

* Indicates required field

Your Name *

First

Last

Your Child's Name *

First

Last

Do you plan on keeping and/or resuming services at Bringing Therapy Home? *

Email *

What team member(s) does your child work with? *

Do you prefer services to occur at the center or through tele-therapy? *

How often do you want your child to receive therapy? *

What services do you want to keep and/or resume? *

What is your preference on a day/timeframe? *

Any additional feedback you would like to provide? *

Submit