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Therapeutic Riding Caregiver/Case Manager Evaluation

Name of Participant
MM slash DD slash YYYY
MM slash DD slash YYYY
Caregiver/Case Manager

Thank you for supporting your rider/participant at Quantum Leap Farm. We would appreciate it if you would take a few minutes to tell us how the experience at the Farm has benefitted your rider/participant Please circle the response that best describes your feelings. Thank you for your help!

1) Riding at Quantum Leap Farm has helped my rider/participant improve his/her physical well-being.
2) Riding at Quantum Leap Farm has helped my rider/participant improve his/her self-confidence.
3) Riding at Quantum Leap Farm has helped my rider/participant improve his/her postural control.
4) Riding at Quantum Leap Farm has helped my rider/participant improve his/her balance.
5) Riding at Quantum Leap Farm has helped my rider/participant improve his/her flexibility.
6) I believe that riding or participating in services at Quantum Leap Farm has improved the quality of life for my rider/participant.
7) I believe that when my rider/participant receives services at Quantum he/she is safe.
9) I believe that participating in services at Quantum Leap Farm has had a positive impact on my daily living.
8) I am very satisfied by the services my rider/participant receives at Quantum Leap Farm.
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