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* 1. Which respite services do you receive from Aspire (check all that apply):

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* 2. Is it easy to schedule Respite Services from Aspire when you need them?

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* 3. Are you satisfied with the frequency of your Respite Services?

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* 4. If there is something you would change, what would it be?

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* 5. When you have asked for an improvement, has the agency staff responded in a timely manner?

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* 6. Were you satisfied with the outcome of the resolution of your request?

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* 7. How can we better support you during your Respite Services?

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* 8. If you would like a personal response to your comments, please leave your name and phone number.

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