Shining Star Questionnaire

We are so delighted to feature your child as a SMart Center Shining Star. Your story will inspire hope for other SM families! Please complete the form below with as much information as you are comfortable with. For reference, please puruse our Shining Star Success Stories on our website.

Child/Teen's First & Last Name *

Your email in case we have questions *

How old was your child when you first noticed he/she was mute in select settings? *

Please briefly summarize where/when your child was mute/not mute (2-3 sentences is fine!) *

Was your child in treatment for Selective Mutism, Social Anxiety, or related disorders before finding the SMart Center? If yes, where? *

What brought you to seek treatment at the SMart Center? What makes S-CAT® treatment different from other methods you may have tried before finding the SMart Center, if any? *

What SMart Center services did you use? Select all that apply: *

How often do/did you consult with the SMart Center? *

What changes have you noticed? Please describe your child's overall progress, including functioning in school, at home, with friends and teachers, and any changes you have seen since starting treatment. *

What S-CAT® strategies helped the most? *

Do you have any "key" advice for parents going through it now? *

If your child/teen is willing to share a brief sentence or two about he/she is feeling now, please enter it below.

Can we use your child’s name, or do you prefer an alias? *

Yes, you can use my child's first name

No, please use an alias

Please upload a before picture of your child/teen. Videos are acceptable too! If you don't feel comfortable sharing photos, we can use stock images.

Please upload an after picture of your child/teen.

Would you like to serve as a reference for families looking to speak with parents who have been through SMart Center program(s)? If yes, we will only supply your email address. *

Yes

No