Client/Customer Satisfaction 2012
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1. Service Characteristics

Please take a few minutes to complete this survey on the quality of service we provide. We welcome your feedback and appreciate your honesty. With your help, we hope to strengthen the bond between our clients.

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1. Please rank, your criteria for choosing an agency.

	Most Important	Very Important	Important	Less Important	Not Important
Knowledge and Professionalism of Staff	*Please rank, your criteria for choosing an agency. Knowledge and Professionalism of Staff Most Important	Knowledge and Professionalism of Staff Very Important	Knowledge and Professionalism of Staff Important	Knowledge and Professionalism of Staff Less Important	Knowledge and Professionalism of Staff Not Important
Previous positive history with an agency	Previous positive history with an agency Most Important	Previous positive history with an agency Very Important	Previous positive history with an agency Important	Previous positive history with an agency Less Important	Previous positive history with an agency Not Important
Location	Location Most Important	Location Very Important	Location Important	Location Less Important	Location Not Important
Lowest rate	Lowest rate Most Important	Lowest rate Very Important	Lowest rate Important	Lowest rate Less Important	Lowest rate Not Important
Responsiveness to requests	Responsiveness to requests Most Important	Responsiveness to requests Very Important	Responsiveness to requests Important	Responsiveness to requests Less Important	Responsiveness to requests Not Important
Emphasis in Individual Care Treatment and Services	Emphasis in Individual Care Treatment and Services Most Important	Emphasis in Individual Care Treatment and Services Very Important	Emphasis in Individual Care Treatment and Services Important	Emphasis in Individual Care Treatment and Services Less Important	Emphasis in Individual Care Treatment and Services Not Important
Other	Other Most Important	Other Very Important	Other Important	Other Less Important	Other Not Important

Other (please specify)

2. Please rate the following questions.

	Excellent	Above Average	Average	Below Average	Poor	N/A
The quality of our responses to your questions and concerns.	*Please rate the following questions. The quality of our responses to your questions and concerns. Excellent	The quality of our responses to your questions and concerns. Above Average	The quality of our responses to your questions and concerns. Average	The quality of our responses to your questions and concerns. Below Average	The quality of our responses to your questions and concerns. Poor	The quality of our responses to your questions and concerns. N/A
The timeliness of our response to your needs.	The timeliness of our response to your needs. Excellent	The timeliness of our response to your needs. Above Average	The timeliness of our response to your needs. Average	The timeliness of our response to your needs. Below Average	The timeliness of our response to your needs. Poor	The timeliness of our response to your needs. N/A
The knowledge level of our staff.	The knowledge level of our staff. Excellent	The knowledge level of our staff. Above Average	The knowledge level of our staff. Average	The knowledge level of our staff. Below Average	The knowledge level of our staff. Poor	The knowledge level of our staff. N/A
Agency Leaders keeps you informed of changes.	Agency Leaders keeps you informed of changes. Excellent	Agency Leaders keeps you informed of changes. Above Average	Agency Leaders keeps you informed of changes. Average	Agency Leaders keeps you informed of changes. Below Average	Agency Leaders keeps you informed of changes. Poor	Agency Leaders keeps you informed of changes. N/A
Our ability to anticipate your needs and provide assistance pro actively.	Our ability to anticipate your needs and provide assistance pro actively. Excellent	Our ability to anticipate your needs and provide assistance pro actively. Above Average	Our ability to anticipate your needs and provide assistance pro actively. Average	Our ability to anticipate your needs and provide assistance pro actively. Below Average	Our ability to anticipate your needs and provide assistance pro actively. Poor	Our ability to anticipate your needs and provide assistance pro actively. N/A
Our products and services we provide meet your objectives.	Our products and services we provide meet your objectives. Excellent	Our products and services we provide meet your objectives. Above Average	Our products and services we provide meet your objectives. Average	Our products and services we provide meet your objectives. Below Average	Our products and services we provide meet your objectives. Poor	Our products and services we provide meet your objectives. N/A
How would you rate the quality of service you have received?	How would you rate the quality of service you have received? Excellent	How would you rate the quality of service you have received? Above Average	How would you rate the quality of service you have received? Average	How would you rate the quality of service you have received? Below Average	How would you rate the quality of service you have received? Poor	How would you rate the quality of service you have received? N/A
To what extent did you get the kind of service you wanted?	To what extent did you get the kind of service you wanted? Excellent	To what extent did you get the kind of service you wanted? Above Average	To what extent did you get the kind of service you wanted? Average	To what extent did you get the kind of service you wanted? Below Average	To what extent did you get the kind of service you wanted? Poor	To what extent did you get the kind of service you wanted? N/A
To what extent has our porgram met your needs?	To what extent has our porgram met your needs? Excellent	To what extent has our porgram met your needs? Above Average	To what extent has our porgram met your needs? Average	To what extent has our porgram met your needs? Below Average	To what extent has our porgram met your needs? Poor	To what extent has our porgram met your needs? N/A
How satisfied are you with the amount of help you have received?	How satisfied are you with the amount of help you have received? Excellent	How satisfied are you with the amount of help you have received? Above Average	How satisfied are you with the amount of help you have received? Average	How satisfied are you with the amount of help you have received? Below Average	How satisfied are you with the amount of help you have received? Poor	How satisfied are you with the amount of help you have received? N/A
Did you feel safe?	Did you feel safe? Excellent	Did you feel safe? Above Average	Did you feel safe? Average	Did you feel safe? Below Average	Did you feel safe? Poor	Did you feel safe? N/A
How satisfied were you with the Admission Process?	How satisfied were you with the Admission Process? Excellent	How satisfied were you with the Admission Process? Above Average	How satisfied were you with the Admission Process? Average	How satisfied were you with the Admission Process? Below Average	How satisfied were you with the Admission Process? Poor	How satisfied were you with the Admission Process? N/A
How satisfied were you with the Physical Plant?	How satisfied were you with the Physical Plant? Excellent	How satisfied were you with the Physical Plant? Above Average	How satisfied were you with the Physical Plant? Average	How satisfied were you with the Physical Plant? Below Average	How satisfied were you with the Physical Plant? Poor	How satisfied were you with the Physical Plant? N/A
How satisfied were you with the course of treatment?	How satisfied were you with the course of treatment? Excellent	How satisfied were you with the course of treatment? Above Average	How satisfied were you with the course of treatment? Average	How satisfied were you with the course of treatment? Below Average	How satisfied were you with the course of treatment? Poor	How satisfied were you with the course of treatment? N/A
How satisfied were you with the outcome of treatment?	How satisfied were you with the outcome of treatment? Excellent	How satisfied were you with the outcome of treatment? Above Average	How satisfied were you with the outcome of treatment? Average	How satisfied were you with the outcome of treatment? Below Average	How satisfied were you with the outcome of treatment? Poor	How satisfied were you with the outcome of treatment? N/A
Overall, how do you rank our services to you.	Overall, how do you rank our services to you. Excellent	Overall, how do you rank our services to you. Above Average	Overall, how do you rank our services to you. Average	Overall, how do you rank our services to you. Below Average	Overall, how do you rank our services to you. Poor	Overall, how do you rank our services to you. N/A

3. What or who was most helpful to you?

What or who was most helpful to you?

4. How could we improve our services?

How could we improve our services?

5. How would you prefer for us to provide most communications?

How would you prefer for us to provide most communications? Email

Phone

Mail

Face-to-Face