Dial Help Satisfaction Survey
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1. Default Section
1
. Thank you for using Dial Help Services! For quality improvement and agency funding opportunities it is helpful for us to collect information and feedback from persons using our services. Which Dial Help Program Did You Utilize?
Thank you for using Dial Help Services! For quality improvement and agency funding opportunities it is helpful for us to collect information and feedback from persons using our services. Which Dial Help Program Did You Utilize?
Alcohol Highway Safety Class
Anger Managment
Counseling
Domestic Violence Intervention Program
Family Support
Helpline
Instant Messaging
Other
Prevention Services
Victim Services
Other (please specify)
2
. What gender are you?
What gender are you?
Female
Male
Transgendered
3
. What ethnicity are you?
What ethnicity are you?
African American
Asian
Caucasian
First Nations
Hispanic or Latino
Native American
Pacific Islander
4
. What age are you?
What age are you?
0-12
13-17
18-29
30-44
45-64
65+
Professional
5
. Is English your native language? If not what is your native language?
Is English your native language? If not what is your native language?
Yes
No
Other (please specify)
6
. Was the Infromation you received from Dial Help Accurate?
If no, please elaborate in order to help us better serve a similar request.
Yes
Somewhat
No
N/A
Yes
*
Was the Infromation you received from Dial Help Accurate? If no, please elaborate in order to help us better serve a similar request. Yes Yes
Yes
Yes Somewhat
Yes
Yes No
Yes N/A
No
No Yes
No
No Somewhat
No
No No
No N/A
Other (please specify)
7
. Was the Dial Help Worker Helpful?
Yes
Somewhat
No
Yes
*
Was the Dial Help Worker Helpful? Yes Yes
Yes
Yes Somewhat
Yes
Yes No
No
No Yes
No
No Somewhat
No
No No
Other (please specify)
8
. (Optional) If you have any comments, concerns, or would like to express your feedback directly to Dial Help's Executive Director or Recipient Right's Officer please complete the following information. You need not fill out this information in order to complete this survey.
(Optional) If you have any comments, concerns, or would like to express your feedback directly to Dial Help's Executive Director or Recipient Right's Officer please complete the following information. You need not fill out this information in order to complete this survey.
Name:
Company:
Address:
Address 2:
City/Town:
State:
-- select state --
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP/Postal Code:
Country:
Email Address:
Phone Number:
9
. Please feel free to leave Dial Help your Feedback, Comments, and/or Suggestions!
Please feel free to leave Dial Help your Feedback, Comments, and/or Suggestions!
10
. I give permission to Dial Help Inc. to utilize my comments (from question #9 of this survey) anonymously in promotional materials. Please select yes or no. Thank you very much for participating in our survey, it helps us improve our services!
I give permission to Dial Help Inc. to utilize my comments (from question #9 of this survey) anonymously in promotional materials. Please select yes or no. Thank you very much for participating in our survey, it helps us improve our services!
Yes
No
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