Provider Satisfaction Form

DDSi Provider Satisfaction Form

On a scale of 1-6 (6 = best), select the option that describes your level of satisfaction with your DDSi Behavior Consultant.*

Accessibility. Can I reach the BC when I need to? If I leave a message, does the BC get back to me in a timely manner?

Responsiveness. When I ask the BC for something, do I get what I need quickly?

Visit Frequency. Does the BC visit the site enough to know what is happening with the consumer(s)? Is the BC there at the right times? Does the BC remain on site for a sufficient length of time? Does the BC attend all scheduled meetings?

Thoroughness. Does the BC check the record, talk to staff and interact with the consumer enough to provide effective assistance? Does the BC engage in discussions at meetings?

Helpfulness. Does the BC provide interventions that work with the consumer(s)? If I have a special need can I count on the BC to get me what I require?

Knowledge. Does the BC seem to have comprehensive knowledge of intellectual disabilities, dual diagnosis, medications and behavior analysis? Does the BC come up with appropriate solutions to problems?

Additional Comments

If you would like to connect with a supervisor, please check the box below and enter your contact information.

Yes, I would like a supervisor to get in touch

Name*

First NameLast Name

Preferred Method of Contact*

PhoneEmail

Phone Number*

Area CodePhone Number

Email*

example@example.com

Accessibility

Responsiveness

Visit Frequency

Thoroughness

Helpfulness