Emerging Butterflies Therapeutic Care – Start Up Survey

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Emerging Butterflies – Start Up Survey

To help determine what services would best serve the community, please answer a few questions to help guide us in the right direction. At the end of the survey you will have the option to provide your contact information to be used when the services are available.

Services Survey

Would you like after hours care, so that you may go out (shopping, eating, meet a friend, have some alone time, etc)? *

Are you aware of childcare providers who have this service? *

Yes, but I’ve never used it
Yes, I use it
No

Does this service interest you? If so, how often do you think you would use it? *

Yes, 1-3 times a week
Yes, 4-7 times a week
Yes, 1-2 times a month
Yes, Just a few times a year
No

Would you like overnight care, for a date night, business trip, stay-cation, or vacation? *

Are you aware of childcare providers who have this service? *

Yes, but I’ve never used it
Yes, I use it
No

Does this service interest you? If so, how would you use it? *

Yes, single night during the week
Yes, single night on a weekend
Yes, few days at a time
Yes, a week at a time

With safety concerns alleviated, where would you prefer we care for your loved one? *

At a center
At my home
Sometimes at home, but mostly in a center
Sometimes at a center, but mostly in my home

Have you considered allowing your loved one to move into shared housing with a resident caregiver? *

No, not interested.
No, but I'm interested.
Yes, but need more information
Yes, but decided not to
Yes, they are in shared housing now

Would you be willing to volunteer your time to reduce the cost of your loved one’s care? *

Yes
No
Maybe

Would you be willing to participate in fundraisers to reduce the cost of your loved one’s care? *

Yes, if it reduces the cost of care
Yes, if proceeds go to the cost of my loved ones care
No

Is there an issue with your loved one’s care that you are stressing over? *

Yes, explain below
No

Name (Optional)

First

Last

Email (Optional)

Phone (Numbers Only) (Optional)

Questions, Comment, or Explain Your Answers here