Satisfaction with ARCH National Respite Locator Immediate

Thank you for using the online ARCH National Respite Locator Service to search for respite providers or programs and/or for additional respite resources. We would very much appreciate it if you could take just a minute to respond to this short survey. It will help us make the respite locator more responsive to your needs.

Question Title

* 1. How useful was the Respite Locator Service overall?

Extremely useful

Very useful

Useful

Somewhat useful

Not at all useful

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* 2. Please indicate which categories of information were useful?

Respite Provider Lists

Medicaid Waivers

Other Public Funding Sources

General Caregiving Resources

State Contacts for More Information

What other information would you like to see included in the Respite Locator Service?

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* 3. How user-friendly is the online Respite Locator Service?

Extremely user-friendly

Very user-friendly

User-friendly

Somewhat user-friendly

Not at all user-friendly

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* 4. How many times have you used the National Respite Locator Service

This is the first time

2-4 times

More than 4 times

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* 5. How likely are you to use the Respite Locator Service again?

Extremely likely

Very likely

Likely

Somewhat likely

Not at all likely

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* 6. How likely are you to recommend the Respite Locator Service to others?

Extremely likely

Very likely

Likely

Somewhat likely

Not at all likely

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* 7. Are you a:

Family Caregiver

Care Recipient

Other family member

Neighbor or Friend

Other (please specify)

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* 8. If you are not seeking respite for yourself, are you seeking respite information as a representative of:

Respite Provider

Lifespan Respite Program

State Government Agency

Local Government Agency

Aging and Disability Resource Center

State Respite Coalition

Caregiver Coalition

National Organization

Private State disability or aging organization

Community-based organization

Faith-based organization

Private insurance company

Hospital or health care facility

Veterans Affairs Caregiver Program

Other (please specify)

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* 9. Please provide any additional feedback.

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* 10. Please let us know which city and state you are from. The remaining contact information is optional. If you would like us to get back to you to provide assistance, please provide your email address.

Name:

Company:

Address:

Address 2:

City/Town: *

State: *

ZIP:

Country:

Email Address:

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