Referral Follow Up Survey

1.  Did you find child care for your child(ren)?    -- child care status -- Found care from Child Care Choices list Found care from other sources Decided care not needed Did not find care Still looking Put my name on a waiting list Decided to keep former care

2.  If you found care, how would you rate the quality of that person or center?    -- rate quality -- Excellent Good Satisfactory Fair Poor No response

3.  How would you rate the response you got if you called Child Care Choices on the phone? -- rate response -- Very helpful Helpful Somewhat helpful Not helpful No response

4.  What problems did you encounter in your search?  -- problems encountered -- None Cost too high No openings Schedule Location Quality Type of care Program

5.  Will you use Child Care Choices again if you need to find child care again?  Yes  No

6.  Did you find the packet of materials informative and helpful?  Yes   No

7. How did we send the referral information to you? -- referral sent -- Email Post Office

8. How do you prefer to receive your information? -- receive information -- Email Post Office

9. Did you find the Child Care Choices website user friendly?  -- CCC website -- Found it easy to use Did not use the website Found it of average convenience Found it hard to use

Thanks for your help in filling out the survey.  It will help Child Care Choices as we work to improve our services.  Your name is for our records only;  it will be only be used internally. 
First Name    Last Name

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