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1. CAANH Customer Satisfaction Survey 2011

Thank you for taking the time to answer the following questions for us. Your responses will allow CAANH to improve our services.

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* 1. How long did you wait to be seen?

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* 2. Were you served in a professional manner?

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* 3. Date of service:

Date

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* 4. Why did you visit CAANH today? (Please selct all that apply.):

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* 5. Please rate your level of agreement or disagreement of the following statements:

  Strongly Agree Agree Disagree Strongly Disagree N/A
The CAANH reception area was clean, comfortable, and welcoming
CAANH staff treated me with respect
CAANH staff were caring and supportive
CAANH staff provided me with information about available services and resourceful options
I received the services I needed
I was an active participant in stating my needs

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* 6. Including today's service, how many services did you receive at CAANH in the past year?

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* 7. If you could change one thing about CAANH what would it be?:

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* 8. If a friend of yours told you that she/he was considering going to CAANH for help, would you: (please select one):

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