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Speech and Language Disorder Facts
What is Speech Pathology?
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Which Speech Path did you work with?
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I, or my child attended Speech and Language Classes for:
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Articulation
Language Development
Accent Reduction
Fluency
Voice
IBI Program
Evaluation/Assessment
Other
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Location of Services
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Home
Office
School
Services Discontinued Because:
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Problem Corrected
Insurance Depleted
Scheduling Difficulties
Prefer Not to Say
Other
Other
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Improvement in Skills
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Excellent
Very good
Good
OK
Needs Improvement
N/A
Appropriateness of Activities
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Excellent
Very Good
Good
OK
Needs Improvement
Feedback to Parents
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Excellent
Very Good
Good
Ok
Needs improvement
Feedback to Other Professionals
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N/A
Excellent
Very Good
Good
OK
Needs Improvement
Service has been Prompt and Professional
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Excellent
Very Good
Good
Ok
Needs Improvement
Speech Lang. Pathologist's rapport with Client
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Excellent
Very good
Good
Ok
Needs Improvement
How many hours did you see us?
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Less than 5
5-10
10-20
20+
Rather Not Say
How would you rate the experience?
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5--Excellent, my child had a wonderful time
4--Great! My child had significant improvement
3--Satisfactory, my child had moderate improvement
2--Somewhat satisfied. My child has had little improvement
1--Not satisfied, my child has had no improvement
Prefer not to say
What did you like about the services?
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What do you feel could be improved?
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