Satisfaction with ARCH National Respite Locator Immediate Survey

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.

1. How useful was the Respite Locator Service overall?

How useful was the Respite Locator Service overall? Extremely useful

Very useful

Useful

Somewhat useful

Not at all useful

2. Please indciate which categories of information were useful?

Please indciate 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?

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

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

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

How many times have you used the National Respite Locator Service This is the first time

2-4 times

More than 4 times

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

How likely are you to use the Respite Locator Service again? Extremely likely

Very likely

Likely

Somewhat likely

Not at all likely

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

How likely are you to recommend the Respite Locator Service to others? Extremely likely

Very likely

Likely

Somewhat likely

Not at all likely

7. Are you a:

Are you a: Family Caregiver

Care Recipient

Other family member

Neighbor or Friend

Other (please specify)

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

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)

*

9. Please let us know which city and state you are from. Your name, street address and phone number are optional. If you would like to be added to our email list, click here

Please let us know which city and state you are from. Your name, street address and phone number are optional. If you would like to be added to our email list, click here Name:
Company:
Address:
Address 2:
City/Town:
State:
ZIP:
Country:
Email Address: