PAT Family Feedback Survey

1.	I feel comfortable talking with my parent educator*
	I feel comfortable talking with my parent educator* Strongly Agree  Agree  Neutral  Disagree  Strongly Disagree

2.	My parent educator is genuinely interested in me.*
	My parent educator is genuinely interested in me.* Strongly Agree  Agree  Neutral  Disagree  Strongly Disagree

3.	My parent educator encourages me to interact with and observe my child.
	My parent educator encourages me to interact with and observe my child. Strongly Agree  Agree  Neutral  Disagree  Strongly Disagree

4.	My parent educator helps me think about setting goals.
	My parent educator helps me think about setting goals. Strongly Agree  Agree  Neutral  Disagree  Strongly Disagree

5.	My parent educator helps me find community resources when I need it.
	My parent educator helps me find community resources when I need it. Strongly Agree  Agree  Neutral  Disagree  Strongly Disagree

6.	My parent educator provides me with useful information about parenting and child development.
	My parent educator provides me with useful information about parenting and child development. Strongly Agree  Agree  Neutral  Disagree  Strongly Disagree

7.	My parent educator gives me handouts that help me continue learning about parenting.
	My parent educator gives me handouts that help me continue learning about parenting. Strongly Agree  Agree  Neutral  Disagree  Strongly Disagree

8.	I am satisfied with the quality of my home visits.
	I am satisfied with the quality of my home visits. Strongly Agree  Agree  Neutral  Disagree  Strongly Disagree

9.	I am satisfied with the number of playgroups offered.
	I am satisfied with the number of playgroups offered. Strongly Agree  Agree  Neutral  Disagree  Strongly Disagree

10.	I am satisfied with the number of home visits I received.
	I am satisfied with the number of home visits I received. Strongly Agree  Agree  Neutral  Disagree  Strongly Disagree

11.	I would recommend this program to a friend.
	I would recommend this program to a friend. Strongly Agree  Agree  Neutral  Disagree  Strongly Disagree

12.	What about the program has been the most helpful for you?

13.	What could we do to improve the program?

14.	Do you know someone you would like to refer to our program? Name: Phone Number: