Feedback Form

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Please write your feedback on the following questions to help us understand your opinion of your child's developments and experiences in Potentials Clinic. We want to provide you and your family with the best service possible so please share with us what you think is great and what you think needs improvement.

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1.I am satisfied with schedules, timing and coordination of therapies at Potentials.*

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Agree

Agree Somewhat

Somewhat Disagree

Disagree

Comments:

2.We are pleased with the warmth and caring of the staff at Potentials.*

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Agree

Agree Somewhat

Somewhat Disagree

Disagree

Comments:

3. Please tell us about the skills your child has gained during the time they have been attending therapy at Potentials, following are some suggestions of skill areas:

• looking and sharing joy (verbal, gesture, sounds) • greeting (looking, gestures, verbal) • playing with same toys in a new way, or with a variety of toys & materials • singing and imitating rhymes • turn taking, playing games • receptive language, verbal expressions • writing skills, letter formation • singing and imitating rhymes • greater tolerance to foods and textures

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4. Please tell us about the skills you wish your child could gain from therapy at Potentials.

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5. Please share any concerns you might have about your experience at Potentials.

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Potentials Address B-4, Kalindi Colony, New Delhi - 110065

Phone: +91 9811798060, +91 9811798930

Email: contact@potentialsindia.com

For Internships, workshops and trianing and jobs contact @ opportunities@potentialsindia.com

Feedback Form

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