Registered Behavior Technician Feedback Form
Please share your feedback about your experience with a Registered Behavior Technician. Your input helps us improve service quality.
Date of Service
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Technician's Name (if known)
Overall Satisfaction
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1
2
3
4
5
Professionalism of Technician
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1
2
3
4
5
Communication Skills
1
2
3
4
5
Was the technician respectful and courteous?
*
Yes
No
How clearly did the technician explain procedures or activities?
Very clearly
Somewhat clearly
Not clear
What did you appreciate most about your experience?
Is there anything that could be improved?
Additional Comments
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