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* 1. Reason for most recent visit:

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* 2. How many years have you been licensed?

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* 3. Name of social worker who visited your home:

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* 4. Please rate the following statements by checking your response:

  Poor Fair Good Very Good Excellent
The visit focused on the safety and well-being of the consumer (adults or children) in care.
The visit was conducted courteously and respectfully.
My licensor is helpful, supportive and knowledgable in discussing issues regarding the licensed services and consumers you serve.
My licensor is consistent in interpretation and enforcement of licensing rules.
My licensor is accessible and responds to my phone calls and/or messages in a timely manner.
When I contact the licensing office, I receive prompt and courteous service.
Overall, how would you rate the services from the licensing unit?

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* 5. Have you visited the childcare licensing website?

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* 6. If you've visited the childcare licensing website, did you find what you were looking for?

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* 7. Do we have your e-mail address?

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* 8. If we do not have your e-mail address, please provide it below (it helps us communicate more efficiently).

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* 9. What if any, other information would you like added to the website?

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* 10. What else would you like us to know?

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