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CONSUMER SATISFACTION SURVEY

The Consumer Satisfaction Survey can be filled out on-line and submitted over the Web. Or, you can download the Consumer Satisfaction Survey in Adobe Portable Document Format, to print and mail into Options For Independence. Please note, in order to download this form, you must have Adobe Acrobat Reader installed on your computer. If you do not have this software, click on the Adobe icon to download a free copy now.

Get Adobe Acrobat

PLEASE NOTE: Your browser must be able to support "forms" (eg. Netscape, Explorer, Lynx). If you are using some other browser, please e-mail your membership request with all the information below to:

options@optionsforindependence.org

Please answer all questions that apply to you.

 

How would you rate your first contact with Options?

    Great
    Good
    Fair
    Poor

How did you learn about Options?

    Friend
    Family Member
    Agency
    Other (if other, please put where):
         

Did Options return your telephone call(s) in a timely manner?

    Yes
    No

Did you receive the information and/or service(s) you requested?

    Yes
    No

Which service(s) did you request?

         

Was the staff courteous?

    Yes
    No

Was the information/service(s) you received helpful to you?

    Yes
    No

Were you informed of other services offered at Options?

    Yes
    No

Were you part of the decision making process?

    Yes
    No

After working with Option's staff, do you feel that you would be able to advocate for yourself should a similar issue arise?

    Yes
    No

Would you recommend Option's services to a friend or relative?

    Yes
    No

Has your life changed since coming to Options? (If you would like to share how your life has changed with us, please add your commtents to the Additional Comments box below.)

    Yes
    No

Additional Comments:

 


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