Feedback Form for Clients, Families and Caregivers

Feedback Form for Clients, Families and Caregivers
Private, Confidential and Secure

At ErinoakKids we strive to provide quality care and services to clients and families. We need your feedback to continuously improve and serve you better. Fields marked with an asterisk (*) must be completed.

Thank you for your valuable feedback!

You can give us your feedback anonymously, but we encourage you to provide your contact information so that we can follow up with you.

If you would like to speak with someone, we are available by phone at 905-855-2690; Toll Free: 1-877-374-6625.
Are you an ErinoakKids client, family member or caregiver?
Which service did you receive that you would like to give feedback on? (e.g., Physiotherapy, Speech Language Therapy, Autism Services, etc.):
Location where you received services:
Please share your feedback. What worked well, and where can we improve? Any suggestions or compliments are welcome
First Name
Last Name
Phone Number
Format: (000)000-0000.
Would you like to be contacted for follow-up?
Please verify that you are human
Submission Date

YearMonthDay
4 digit year, 2 digit month, 2 digit dayDate
Hour MinutesAM/PM Option
Form Name
Should be Empty: