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Date
*
Month
/
Day
/
Year
ACCESS - The referral and admission process was easy and organized.
*
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Not applicable
Staff was available when I needed them.
*
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Not applicable
It was easy for me to get to the program office.
*
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Not applicable
EFFECTIVENESS - I received services that were very helpful.
*
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Not applicable
The staff helped me find other services that I needed.
*
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Not applicable
This program has helped me improve the quality of my life.
*
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Not applicable
EFFICIENCY - If I had a complaint(s), it was handled well.
*
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Not applicable
My needs were adequately addressed.
*
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Not applicable
OVERALL SATISFACTION - I was treated with respect.
*
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Not applicable
I am satisfied with the services I received.
*
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Not applicable
Additional Comments / How could we better serve you?
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