CIL Consumer Satisfaction SurveyCIL Consumer Satisfaction Survey

Please tell us about your experience at CIL, and how we can better help you in the future.

1. Which location did you visit today?

Which location did you visit today? Berkeley

Called in

Downtown Oakland

Fruitvale

Telegraph Ave

Other (please specify)

2. Which services did you use today? Please chose all that apply.

Which services did you use today? Please chose all that apply. Advocacy

Assistive Technology (AT)

Benefits

Blind Services

Client Assistance Program (CAP)

Deaf Services

Employment

Housing

Independent Living Skills

Information & Referral

Living Well

Residential Access

Travel Training

Wheelchair Repair/Re-use

Other (please specify)

3. How helpful were the services you receive today:

How helpful were the services you receive today: Great! Very helpful

OK, somewhat helpful

Neutral/no opinion

Bad

Other (please specify)

4. Please tell us about the staff you worked with:

	Strongly Agree	Agree	No Opinion	Disagree	Strongly Disagree	Does not apply to me
Staff members are well informed	*Please tell us about the staff you worked with: Staff members are well informed Strongly Agree	Staff members are well informed Agree	Staff members are well informed No Opinion	Staff members are well informed Disagree	Staff members are well informed Strongly Disagree	Staff members are well informed Does not apply to me
Staff members treat me with respect	Staff members treat me with respect Strongly Agree	Staff members treat me with respect Agree	Staff members treat me with respect No Opinion	Staff members treat me with respect Disagree	Staff members treat me with respect Strongly Disagree	Staff members treat me with respect Does not apply to me
Staff members work with me to set goals that are important to me	Staff members work with me to set goals that are important to me Strongly Agree	Staff members work with me to set goals that are important to me Agree	Staff members work with me to set goals that are important to me No Opinion	Staff members work with me to set goals that are important to me Disagree	Staff members work with me to set goals that are important to me Strongly Disagree	Staff members work with me to set goals that are important to me Does not apply to me
I receive my services in a timely manner	I receive my services in a timely manner Strongly Agree	I receive my services in a timely manner Agree	I receive my services in a timely manner No Opinion	I receive my services in a timely manner Disagree	I receive my services in a timely manner Strongly Disagree	I receive my services in a timely manner Does not apply to me
The services I am receiving meet my needs	The services I am receiving meet my needs Strongly Agree	The services I am receiving meet my needs Agree	The services I am receiving meet my needs No Opinion	The services I am receiving meet my needs Disagree	The services I am receiving meet my needs Strongly Disagree	The services I am receiving meet my needs Does not apply to me
I am satisfied with my overall experience	I am satisfied with my overall experience Strongly Agree	I am satisfied with my overall experience Agree	I am satisfied with my overall experience No Opinion	I am satisfied with my overall experience Disagree	I am satisfied with my overall experience Strongly Disagree	I am satisfied with my overall experience Does not apply to me

5. What is different in your life as a result of working with us?

What is different in your life as a result of working with us?

6. Please tell us about yourself. What is your gender? (This question is optional.)

Please tell us about yourself. What is your gender? (This question is optional.) Male

Female

Other (please specify)

7. How old are you? (This question is optional.)

How old are you? (This question is optional.) Under 18

18-25

25-34

35-44

45-54

55-64

65 and older

8. What is your ZIP code? (This question is optional.)

What is your ZIP code? (This question is optional.)

9. Please tell us about your disability. Please check all that apply.

Please tell us about your disability. Please check all that apply. Cognitive

Mental Health

Physical

Hearing

Vision

Other

10. If you would like someone to get back to you then please leave your name, best way to reach you, and how we can help.

If you would like someone to get back to you then please leave your name, best way to reach you, and how we can help.

11. Is there anything else you would like to tell us?

Is there anything else you would like to tell us?

Thank you for helping us by filling out this survey!